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1712 S, Country Club Drive, Ste 104 Mesa AZ 85210 | |
| (480) 376-0593 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 1712 S, Country Club Drive, Ste 104, Mesa, Arizona |
| Authorized Official Name and Position | Miran Ho (OWNER) |
| Authorized Official Contact | 4803760593 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 920050 Dallas TX 75392-0050 Ph: (714) 845-8500 | 1712 S, Country Club Drive, Ste 104 Mesa AZ 85210 Ph: (480) 376-0593 |
| NPI Number | 1487190880 |
|---|---|
| Provider Enumeration Date | 01/10/2017 |
| Last Update Date | 04/13/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487190880 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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