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General NPI Number Information
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NPI Number | 1821216896
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Entity Type | Organization
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Legal Business Name | INTEGRA MANAGEMENT
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 525 W SOUTHERN AVE 128
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City | MESA
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State | AZ
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Zip | 85210-5031
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Country | US
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Telephone | 480-964-8982
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Fax | 480-644-9945
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Provider Business Mailing Address
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Address Line | 525 W SOUTHERN AVE 128
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City | MESA
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State | AZ
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Zip | 85210-5031
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Country | US
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Telephone | 480-964-8982
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Fax | 480-644-9945
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Authorized Official
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Title or Position | OWNER
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Name | ERIC L KERBS
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Credential | D.D.S.
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Telephone | 480-964-8982
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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 | 6458
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License Number State | AZ
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