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General NPI Number Information
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NPI Number | 1043503840
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Entity Type | Organization
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Legal Business Name | VERVE DENTAL GROUP, LLC
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Dates
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Enumeration Date | 05/26/2011
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Last Update Date | 05/26/2011
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Provider Practice Location Address
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Address Line | 4824 E BASELINE RD STE 140
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City | MESA
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State | AZ
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Zip | 85206-4676
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Country | US
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Telephone | 480-969-4040
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Fax |
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Provider Business Mailing Address
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Address Line | 25 S ARIZONA PL STE 520
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City | CHANDLER
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State | AZ
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Zip | 85225-5533
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Country | US
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Telephone | 480-615-3501
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Fax | 480-897-7060
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID WARKENTIN
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Credential |
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Telephone | 480-615-3501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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