# HERMOSA DENTAL AND ORTHODONTICS GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306277918
- **Authorized official:** MR. RASOUL SALIM (OWNER)
- **Authorized official phone:** (602) 242-0550

## Contact information

- **Practice address:** 3415 W GLENDALE AVE, 30, PHOENIX, AZ 85051-8386
- **Practice address phone:** (602) 242-0550
- **Practice address fax:** (602) 242-4965
- **Mailing address:** 3415 W GLENDALE AVE, 30, PHOENIX, AZ 85051-8386
- **Mailing address phone:** (602) 242-0550
- **Mailing address fax:** (602) 242-4965

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D5067 | AZ | Yes |
| 1223P0300X | Periodontics | D6876 | AZ | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | D8403 | AZ | — |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | D8369 | AZ | — |

## Other

- **Enumeration date:** 12/06/2013
- **Last updated:** 12/06/2013