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General NPI Number Information
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NPI Number | 1063374593
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Entity Type | Organization
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Legal Business Name | MY PEDIATRIC DENTIST PLLC
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Dates
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Enumeration Date | 12/02/2025
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 5215 E SOUTHERN AVE
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City | MESA
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State | AZ
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Zip | 85206-2777
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Country | US
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Telephone | 480-833-2232
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Fax |
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Provider Business Mailing Address
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Address Line | 2045 S VINEYARD STE 153
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City | MESA
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State | AZ
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Zip | 85210-6892
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | AUSTIN MCHENRY
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Credential | DMD
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Telephone | 602-384-7506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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