Healthcare Provider Details

I. General information

NPI: 1225961170
Provider Name (Legal Business Name): DIANA LIN DOUGHERTY GARCIA RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4530 E RAY RD STE 170
PHOENIX AZ
85044-6097
US

IV. Provider business mailing address

2713 E MENLO ST
MESA AZ
85213-1551
US

V. Phone/Fax

Practice location:
  • Phone: 480-477-3090
  • Fax:
Mailing address:
  • Phone: 480-477-3090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH009837
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: