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NPI Code Detail

MEDICARE: SOUTH MESA DENTAL PARTNERS

MEDICARE: SOUTH MESA DENTAL PARTNERS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryD008299AZ

General Provider Information

NPI Number : 1053693531
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTH MESA DENTAL PARTNERS
Provider Business Mailing Address
First Line : 1130 S. COUNTRY CLUB DR
Second Line : STE 101
City : MESA
State : AZ
Zip : 85210-4639
Country : US
Telephone Number : 480-461-9866
Fax Number : 480-461-9861
Provider Business Practice Location Address
First Line : 1130 S. COUNTRY CLUB DR
Second Line : STE 101
City : MESA
State : AZ
Zip : 85210-4639
Country : US
Telephone Number : 480-461-9866
Fax Number : 480-461-9861
Authorized Official
Title or Position : OWNER
Name : DR. TAD BRANDON OLSEN
Credential : DMD
Telephone Number : 480-461-9866
Provider Enumeration Date : 09/12/2011
Last Update Date : 01/14/2026

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1376926303 — DR. JARED SPENCER SMITH DMD
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Practice Location Address:
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1922746858 — JACOB MOORHEAD DMD
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1130 S COUNTRY CLUB DR STE 101
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85210-4639
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Directions to “SOUTH MESA DENTAL PARTNERS ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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