# MOUNTAINSIDE DENTAL GROUP, LLC

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

## Provider details

- **NPI number:** 1518270248
- **Authorized official:** DARON CLARE (GENERAL MANAGER)
- **Authorized official phone:** (480) 981-0590

## Contact information

- **Practice address:** 6549 E UNIVERSITY DR, SUITE B, MESA, AZ 85205-7600
- **Practice address phone:** (480) 981-0590
- **Mailing address:** 6549 E UNIVERSITY DR, SUITE B, MESA, AZ 85205-7600
- **Mailing address phone:** (480) 981-0590

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | L16075880 | AZ | Yes |

## Other

- **Enumeration date:** 07/22/2010
- **Last updated:** 07/22/2010