Healthcare Provider Details

I. General information

NPI: 1437016110
Provider Name (Legal Business Name): NORTH MESA DENTAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 E BROWN RD
MESA AZ
85213-5508
US

IV. Provider business mailing address

19601 N BLACK CANYON HWY STE 201
PHOENIX AZ
85027-4107
US

V. Phone/Fax

Practice location:
  • Phone: 480-660-7111
  • Fax:
Mailing address:
  • Phone: 623-289-3392
  • Fax: 623-289-2015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ARELI VALENCIA
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 623-289-3392