Mesa Kidtastic Dental LLC
Dentist, Pediatric Dentistry in Mesa, AZ. Organization (NPI-2).
NPI number1942841663
StatusActive
Last updated in NPPESOct 3, 2019
Details
- NPI
- 1942841663
- Entity type
- Organization (NPI-2)
- Legal business name
- Mesa Kidtastic Dental LLC
- Organization subpart
- No
- Enumeration date
- Oct 3, 2019
- Last updated
- Oct 3, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223P0221X | Dentist, Pediatric Dentistry | – | – | Yes |
Practice location
1240 W Southern Ave Ste 112Mesa, AZ 85202-4882
Phone 403-733-5437
Mailing address
1240 W Southern Ave Ste 112Mesa, AZ 85202-4882
Phone 403-733-5437
Authorized official
Faith Gaskins
Director Of Credentialing
9728693789
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