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Organization
SOUTH MOUNTAIN DENTAL LLC
Active
Organization
SOUTH MOUNTAIN DENTAL LLC
Active
Other names
South Mountain Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
FAITH GASKINS (DIRECTOR OF CREDENTAILING)
(972) 869-3789
Entity
Organization
Contact information
Practice address
2233 W BASELINE RD STE 104, TEMPE, AZ 85283-1097
(602) 438-9245
Mailing address
2233 W BASELINE RD STE 104, TEMPE, AZ 85283-1097
(602) 438-9245
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
NULL
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
10/18/2021
Last updated
10/18/2021
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