Healthcare Provider Details

I. General information

NPI: 1497935514
Provider Name (Legal Business Name): BRIAN CAHILL, D.D.S., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4540 E BASELINE RD STE 101
MESA AZ
85206-4616
US

IV. Provider business mailing address

4540 E BASELINE RD STE 101
MESA AZ
85206-4616
US

V. Phone/Fax

Practice location:
  • Phone: 480-632-6222
  • Fax: 480-632-7970
Mailing address:
  • Phone: 480-632-6222
  • Fax: 480-632-7970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5089
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number5182
License Number StateAZ

VIII. Authorized Official

Name: DR. BRIAN FRANCIS CAHILL
Title or Position: OWNER
Credential: D.D.S.
Phone: 480-632-6222