Organization · NPI-2

Acacia Dental

Clinic/Center, Dental · Tempe, AZ

NPI number1891907630
StatusActive
Last updated in NPPESJul 25, 2008

Details

NPI
1891907630
Entity type
Organization (NPI-2)
Legal business name
Acacia Dental
Organization subpart
No
Enumeration date
May 4, 2007
Last updated
Jul 25, 2008

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QD0000X Clinic/Center, Dental4342AZYes
122300000X Dentist4342AZ

Other names

  • Mathewsjeffrey A Single Member (Other Name)

Practice location

7517 S. Mcclintock Dr.
Suite 1006
Tempe, AZ 85283-5011

Phone 480-831-7775 · Fax 480-831-8108

Mailing address

1321 E Krista Way
Tempe, AZ 85284-1658

Phone 480-831-7775 · Fax 480-831-8108

Authorized official

Jeffrey Arthur Mathews
Owner
4808317775

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