Healthcare Provider Details

I. General information

NPI: 1093967945
Provider Name (Legal Business Name): SYNERGY DENTAL GROUP, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2008
Last Update Date: 05/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3549 E BROWN RD STE 104
MESA AZ
85213-5508
US

IV. Provider business mailing address

3549 E BROWN RD SUITE #104
MESA AZ
85213-5508
US

V. Phone/Fax

Practice location:
  • Phone: 480-830-2956
  • Fax: 480-830-3019
Mailing address:
  • Phone: 480-830-2956
  • Fax: 480-830-3019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name: DR. LAURENCE SCOTT ADAMS
Title or Position: MANAGER
Credential: DDS
Phone: 480-830-2956