Organization
EAST VALLEY PERIODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PENNY SUE MCKINNEY (OFFICE MANAGER)
(480) 218-7590
Entity
Organization
Contact information
Practice address
6755 E SUPERSTITION SPRINGS BLVD, STE. 102, MESA, AZ 85206-4373
(480) 218-7590
(480) 218-2247
Mailing address
6755 E SUPERSTITION SPRINGS BLVD, STE. 102, MESA, AZ 85206-4373
(480) 218-7590
(480) 218-2247
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
2619
AZ
1223P0300X
Periodontics
7751
AZ
Other
Enumeration date
06/16/2009
Last updated
06/16/2009
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