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General NPI Number Information
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NPI Number | 1215283940
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Entity Type | Organization
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Legal Business Name | MIDEX DENTAL, LLC
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Dates
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Enumeration Date | 07/31/2012
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Last Update Date | 07/31/2012
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Provider Practice Location Address
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Address Line | 6337 N 75TH ST
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City | SCOTTSDALE
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State | AZ
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Zip | 85250-4623
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Country | US
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Telephone | 602-206-6964
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Fax |
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Provider Business Mailing Address
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Address Line | 652 E WARNER RD STE 101
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City | GILBERT
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State | AZ
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Zip | 85296-3071
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Country | US
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Telephone | 480-545-8400
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. DAVID J VELASCO JR.
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Credential | DDS
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Telephone | 602-206-6964
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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 | AZ3740
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License Number State | AZ
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