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General NPI Number Information
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NPI Number | 1427793553
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Entity Type | Organization
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Legal Business Name | VIBE DENTAL PLLC
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Dates
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Enumeration Date | 05/03/2022
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Last Update Date | 05/17/2022
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Provider Practice Location Address
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Address Line | 1855 S COUNTRY CLUB DR STE 101
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City | MESA
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State | AZ
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Zip | 85210-6120
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Country | US
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Telephone | 480-800-8423
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Fax |
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Provider Business Mailing Address
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Address Line | 1855 S COUNTRY CLUB DR STE 101
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City | MESA
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State | AZ
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Zip | 85210-6120
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Country | US
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Telephone | 480-800-8423
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | IZAAC KEVIN JO
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Credential |
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Telephone | 480-977-8787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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