Healthcare Provider Details

I. General information

NPI: 1114189487
Provider Name (Legal Business Name): DESERT MISSION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 11/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 N 5TH ST
PHOENIX AZ
85020-2532
US

IV. Provider business mailing address

9201 N 5TH ST
PHOENIX AZ
85020-2532
US

V. Phone/Fax

Practice location:
  • Phone: 602-870-6060
  • Fax: 602-331-5819
Mailing address:
  • Phone: 602-870-6060
  • Fax: 602-331-5819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberF0049
License Number StateAZ

VIII. Authorized Official

Name: MS. CINDY HALLMAN
Title or Position: VICE PRESIDENT
Credential:
Phone: 602-870-6060