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General NPI Number Information
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NPI Number | 1205667870
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Entity Type | Organization
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Legal Business Name | MESA IMPLANTS & PERIODONTICS, LLC
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Dates
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Enumeration Date | 08/13/2024
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Last Update Date | 08/13/2024
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Provider Practice Location Address
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Address Line | 2812 N NORWALK BLDG 13 SUITE 126
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City | MESA
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State | AZ
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Zip | 85215-1148
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Country | US
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Telephone | 480-203-2666
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Fax | 480-939-2980
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Provider Business Mailing Address
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Address Line | 2812 N NORWALK BLDG 13126
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City | MESA
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State | AZ
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Zip | 85215-1148
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Country | US
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Telephone | 480-203-2666
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Fax | 480-939-2980
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ELODIA MARIA GARCIA
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Credential |
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Telephone | 480-203-2666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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