Healthcare Provider Details

I. General information

NPI: 1437611803
Provider Name (Legal Business Name): MDBB MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 S VAL VISTA DR STE 101
GILBERT AZ
85295-1606
US

IV. Provider business mailing address

2680 S VAL VISTA DR STE 101
GILBERT AZ
85295-1606
US

V. Phone/Fax

Practice location:
  • Phone: 727-522-5599
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: BART PALMISANO
Title or Position: SECRETARY
Credential:
Phone: 723-752-2559