MEDICARE: NORTH MESA DENTAL GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1437016110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH MESA DENTAL GROUP LLC

Provider Business Mailing Address
First Line	:	19601 N BLACK CANYON HWY STE 201
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85027-4107
Country	:	US
Telephone Number	:	623-289-3392
Fax Number	:	623-289-2015

Provider Business Practice Location Address
First Line	:	3505 E BROWN RD
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85213-5508
Country	:	US
Telephone Number	:	480-660-7111
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	ARELI VALENCIA
Credential	:
Telephone Number	:	623-289-3392

Provider Enumeration Date	:	01/06/2026
Last Update Date	:	01/06/2026

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