Healthcare Provider Details

I. General information

NPI: 1811288384
Provider Name (Legal Business Name): SATISH S. KUMAR D.M.D.,M.D.SC.,M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2011
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5855 E STILL CIR
MESA AZ
85206
US

IV. Provider business mailing address

5855 E STILL CIR
MESA AZ
85206-3631
US

V. Phone/Fax

Practice location:
  • Phone: 480-248-8158
  • Fax:
Mailing address:
  • Phone: 480-248-8158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberD010104
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code125Q00000X
TaxonomyOral Medicine Dentistry
License NumberD010104
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License NumberD010104
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: