# MARTIN DENTAL

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MARTIN DENTAL-AIRPARK LLC
- **Other names:** Martin Dental - Mesa, LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1073108890
- **Legal business name:** MARTIN DENTAL-AIRPARK LLC
- **Authorized official:** JAYLENE CRAM (OFFICE MANAGER)
- **Authorized official phone:** (480) 672-2453

## Contact information

- **Practice address:** 1815 S CRISMON RD, 104, MESA, AZ 85209-8520
- **Practice address phone:** (480) 672-2453
- **Practice address fax:** (480) 672-2454
- **Mailing address:** 1815 S CRISMON RD, 104, MESA, AZ 85209
- **Mailing address phone:** (480) 672-2453
- **Mailing address fax:** (480) 672-2454

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/03/2021
- **Last updated:** 03/03/2021