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General NPI Number Information
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NPI Number | 1679463723
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Entity Type | Organization
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Legal Business Name | AZ FAMILY AND KIDS DENTAL MESA LLC
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Dates
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Enumeration Date | 07/08/2025
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 1942 E SOUTHERN AVE STE 103
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City | MESA
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State | AZ
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Zip | 85204-5245
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Country | US
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Telephone | 480-733-9800
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Fax |
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Provider Business Mailing Address
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Address Line | 1942 E SOUTHERN AVE STE 103
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City | MESA
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State | AZ
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Zip | 85204-5245
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Country | US
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Telephone | 480-733-9800
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DANIEL HAUGHT
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Credential | DMD
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Telephone | 928-970-2723
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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 |
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License Number State |
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