# COUNTRY CLUB DENTAL INC.

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

## Provider details

- **NPI number:** 1417121880
- **Authorized official:** FRANCES JOANN FATTOHI (OWNER)
- **Authorized official phone:** (480) 892-8185

## Contact information

- **Practice address:** 3050 S COUNTRY CLUB DR STE 18, MESA, AZ 85210-8365
- **Practice address phone:** (480) 892-8185
- **Mailing address:** 3050 S COUNTRY CLUB DR STE 18, MESA, AZ 85210-8365
- **Mailing address phone:** (480) 892-8185

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | AZ | Yes |

## Other

- **Enumeration date:** 04/16/2008
- **Last updated:** 04/16/2008