Healthcare Provider Details

I. General information

NPI: 1033288733
Provider Name (Legal Business Name): CAMELBACK PEDIATRIC DENTISTRY AND ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 N 44TH ST #101
PHOENIX AZ
85018-2782
US

IV. Provider business mailing address

4901 N 44TH ST #101
PHOENIX AZ
85018-2782
US

V. Phone/Fax

Practice location:
  • Phone: 602-595-3531
  • Fax: 602-595-3431
Mailing address:
  • Phone: 602-595-3531
  • Fax: 602-595-3431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT MARK MIRABELLI
Title or Position: PEDIATRIC DENTIST PRACTICE OWNER
Credential: DMD, MSD
Phone: 602-595-3431