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General NPI Number Information
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NPI Number | 1942552104
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Entity Type | Organization
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Legal Business Name | ARIZONA MINI DENTAL IMPLANT CENTERS MESA, LLC
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Dates
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Enumeration Date | 10/11/2012
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Last Update Date | 10/11/2012
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Provider Practice Location Address
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Address Line | 633 N GILBERT RD
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City | MESA
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State | AZ
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Zip | 85203-6629
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Country | US
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Telephone | 480-898-3053
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Fax | 480-656-4864
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Provider Business Mailing Address
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Address Line | 633 N GILBERT RD
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City | MESA
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State | AZ
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Zip | 85203-6629
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Country | US
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Telephone | 480-898-3053
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Fax | 480-656-4864
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT O CASELDINE
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Credential | DDS
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Telephone | 480-898-3053
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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 | 3008
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License Number State | AZ
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