# HERITAGE TECHNOLOGIES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Desert Grove Family Medical
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093764938
- **Authorized official:** MICHELLE DINSDALE (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (480) 834-7546

## Contact information

- **Practice address:** 1855 N STAPLEY DR, MESA, AZ 85203-3002
- **Practice address phone:** (480) 834-7546
- **Practice address fax:** (480) 833-8313
- **Mailing address:** 1855 N STAPLEY DR, MESA, AZ 85203-3002
- **Mailing address phone:** (480) 834-7546
- **Mailing address fax:** (480) 833-8313

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/09/2006
- **Last updated:** 11/26/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 633795 | — | AZ |