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General NPI Number Information
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NPI Number | 1609039114
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Entity Type | Organization
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Legal Business Name | DESERT PALM SURGICAL GROUP
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Dates
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Enumeration Date | 07/03/2008
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Last Update Date | 07/03/2008
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Provider Practice Location Address
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Address Line | 7930 EAST THOMPSON PEAK PARKWAY SUITE 101
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City | SCOTTSDALE
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State | AZ
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Zip | 85255
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Country | US
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Telephone | 480-947-7700
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Fax | 480-513-8788
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Provider Business Mailing Address
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Address Line | 7930 EAST THOMPSON PEAK PARKWAY SUITE 101
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City | SCOTTSDALE
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State | AZ
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Zip | 85255
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Country | US
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Telephone | 480-947-7700
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Fax | 480-513-8788
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Authorized Official
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Title or Position | OWNER/SURGEON
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Name | DR. MICHELLE LYNN CABRET-CARLOTTI
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Credential | MD, DDS
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Telephone | 480-947-7700
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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 | 5600
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 30196
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License Number State | AZ
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