DoctorDataHub
Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.

COUNTRY CLUB DENTAL MANAGEMENT CO, PC

Active Organization

COUNTRY CLUB DENTAL MANAGEMENT CO, PC is a Dentist organization located in MESA, Arizona. NPI 1164722021 is currently active in the NPPES registry. Verify at CMS.

Dentist · MESA, AZ

Registration Details

NPI Number
1164722021
Provider Type
Organization
NPI Issued
Oct 26, 2010 (15.826312903204 yrs)
Last Updated
Oct 31, 2013
Licenses
D07819 (AZ)
D07819 (AZ)

Practice Information

Address
4704 E SOUTHERN AVE
SUITE #1
MESA, AZ, 852062737
Browse AZ providers · Browse ZIP 85206
Phone
4808899457
Fax
4808899493
Primary Specialty
Dentist
122300000X
Additional Specialty
Dentist
Data sourced from the NPPES National Provider Identifier registry. Healthcare organizations registered in NPPES are assigned an NPI number for use in insurance billing and claims. This information is for informational purposes only. For official verification, use the NPPES NPI Registry.