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Organization
COUNTRY CLUB DENTAL INC.
Active
Organization
COUNTRY CLUB DENTAL INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FRANCES JOANN FATTOHI (OWNER)
(480) 892-8185
Entity
Organization
Contact information
Practice address
3050 S COUNTRY CLUB DR STE 18, MESA, AZ 85210-8365
(480) 892-8185
Mailing address
3050 S COUNTRY CLUB DR STE 18, MESA, AZ 85210-8365
(480) 892-8185
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
AZ
Other
Enumeration date
04/16/2008
Last updated
04/16/2008
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