Healthcare Provider Details

I. General information

NPI: 1457267734
Provider Name (Legal Business Name): CRD PARTNERSHIP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2919 S ELLSWORTH RD STE 128
MESA AZ
85212-2167
US

IV. Provider business mailing address

2919 S ELLSWORTH RD STE 128
MESA AZ
85212-2167
US

V. Phone/Fax

Practice location:
  • Phone: 480-962-1500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: REBECCA RODRIGUEZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 480-962-1500