Organization
TEPHROCACTUS LLC
Active
Other names
Gilbert Road Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
JASEN STIGER (CORPORATE SECRETARY)
(602) 225-0595
Entity
Organization
Contact information
Practice address
2158 N GILBERT RD, MESA, AZ 85203-2109
(480) 649-7200
Mailing address
PO BOX 61025, PHOENIX, AZ 85082-1025
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
F000539
AZ
Other
Enumeration date
01/13/2015
Last updated
04/09/2015
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