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General NPI Number Information
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NPI Number | 1851644504
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Entity Type | Organization
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Legal Business Name | EMBRACEABLE AZ LLC
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Dates
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Enumeration Date | 10/18/2012
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Last Update Date | 10/18/2012
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Provider Practice Location Address
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Address Line | 1130 S COUNTRY CLUB DR SUITE 101
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City | MESA
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State | AZ
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Zip | 85210-4639
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Country | US
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Telephone | 480-461-9866
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Fax |
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Provider Business Mailing Address
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Address Line | 1130 S COUNTRY CLUB DR SUITE 101
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City | MESA
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State | AZ
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Zip | 85210-4639
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Country | US
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Telephone | 480-461-9866
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Fax |
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Authorized Official
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Title or Position | PARTNER / OWNER
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Name | DR. MARK STASI
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Credential | D.D.S.
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Telephone | 303-549-1912
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 8340
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License Number State | AZ
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