# BASELINE ROAD DENTAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Desert Dental Specialists
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366281149
- **Authorized official:** JENNY GARCIA ROCHA (SR TEAM LEAD)
- **Authorized official phone:** (972) 869-3789

## Contact information

- **Practice address:** 3130 E BASELINE RD 105/106, MESA, AZ 85204
- **Practice address phone:** (480) 701-6656
- **Practice address fax:** (480) 452-1614
- **Mailing address:** 3130 E BASELINE RD 105/106, MESA, AZ 85204
- **Mailing address phone:** (480) 701-6656
- **Mailing address fax:** (480) 452-1614

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 05/22/2024
- **Last updated:** 05/22/2024