Healthcare Provider Details

I. General information

NPI: 1063001022
Provider Name (Legal Business Name): HEALING DENTISTRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2021
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 W MCDOWELL RD STE B
PHOENIX AZ
85003-1223
US

IV. Provider business mailing address

125 W MCDOWELL RD STE B
PHOENIX AZ
85003-1223
US

V. Phone/Fax

Practice location:
  • Phone: 602-273-0013
  • Fax:
Mailing address:
  • Phone: 602-273-0013
  • Fax:

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: MARIJA MITIC
Title or Position: DDS
Credential:
Phone: 240-715-8035