# MESA MODERN DENTISTRY, LLP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Mesa Modern Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477821460
- **Authorized official:** DR. CARL C FAIRCHILD DDS (OWNER DOCTOR)
- **Authorized official phone:** (480) 926-2350

## Contact information

- **Practice address:** 3440 E BASELINE RD STE 106, MESA, AZ 85204-7247
- **Practice address phone:** (480) 926-2350
- **Practice address fax:** (480) 926-2366
- **Mailing address:** 2860 MICHELLE FL 2, IRVINE, CA 92606-1008
- **Mailing address phone:** (714) 368-2077
- **Mailing address fax:** (714) 368-2092

## Taxonomy

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

## Other

- **Enumeration date:** 12/06/2011
- **Last updated:** 12/06/2011