Healthcare Provider Details

I. General information

NPI: 1497119945
Provider Name (Legal Business Name): ARIZONA MOBILE DENTAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 05/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 W UNION HILLS DR SUITE 202
PHOENIX AZ
85027-5163
US

IV. Provider business mailing address

33533 W 12 MILE RD SUITE 150
FARMINGTON HILLS MI
48331-3354
US

V. Phone/Fax

Practice location:
  • Phone: 888-833-8441
  • Fax: 888-330-4331
Mailing address:
  • Phone: 888-833-8441
  • Fax: 888-330-4331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL LACORTE
Title or Position: PRESIDENT
Credential: DDS
Phone: 888-833-8441