# DESERT RIDGE IMPLANT & ORAL SURGERY PC

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

## Provider details

- **NPI number:** 1588960512
- **Authorized official:** DR. MATTHEW A. DEFELICE DDS (OWNER)
- **Authorized official phone:** (480) 563-3960

## Contact information

- **Practice address:** 20950 N TATUM BLVD, STE. 120, PHOENIX, AZ 85050-4200
- **Practice address phone:** (480) 563-3960
- **Practice address fax:** (480) 563-3965
- **Mailing address:** 20950 N TATUM BLVD, STE. 120, PHOENIX, AZ 85050-4200
- **Mailing address phone:** (480) 563-3960
- **Mailing address fax:** (480) 563-3965

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 5196 | AZ | Yes |

## Other

- **Enumeration date:** 02/09/2011
- **Last updated:** 04/04/2011