Healthcare Provider Details

I. General information

NPI: 1952236549
Provider Name (Legal Business Name): MASSIA ATALLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7710 W LOWER BUCKEYE RD STE 120
PHOENIX AZ
85043-3439
US

IV. Provider business mailing address

1536 E APOLLO RD
PHOENIX AZ
85042-4466
US

V. Phone/Fax

Practice location:
  • Phone: 623-387-9101
  • Fax:
Mailing address:
  • Phone: 480-469-7615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD012864.
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: