Healthcare Provider Details

I. General information

NPI: 1689589129
Provider Name (Legal Business Name): MY ORTHO DENTIST HIGLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 E SOUTHERN AVE
MESA AZ
85206-2777
US

IV. Provider business mailing address

5215 E SOUTHERN AVE
MESA AZ
85206-2777
US

V. Phone/Fax

Practice location:
  • Phone: 480-833-2232
  • Fax:
Mailing address:
  • Phone: 480-833-2232
  • 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: AUSTIN MCHENRY
Title or Position: PARTNER
Credential: DMD
Phone: 602-384-7506