Healthcare Provider Details

I. General information

NPI: 1760098123
Provider Name (Legal Business Name): AZ MAX DENTAL IMPLANTS PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6755 E SUPERSTITION SPRINGS BLVD STE 103
MESA AZ
85206-4375
US

IV. Provider business mailing address

6755 E SUPERSTITION SPRINGS BLVD STE 103
MESA AZ
85206-4375
US

V. Phone/Fax

Practice location:
  • Phone: 480-830-5866
  • Fax: 480-807-0606
Mailing address:
  • Phone: 480-830-5866
  • Fax: 480-807-0606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. BRENT R BOYSE
Title or Position: MANAGER
Credential: DDS
Phone: 480-830-5866