Organization
MARTIN DENTAL
Active
Parent organization
MARTIN DENTAL-AIRPARK LLC
Other names
Martin Dental - Mesa, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MARTIN DENTAL-AIRPARK LLC
Authorized official
JAYLENE CRAM (OFFICE MANAGER)
(480) 672-2453
Entity
Organization
Contact information
Practice address
1815 S CRISMON RD, 104, MESA, AZ 85209-8520
(480) 672-2453
(480) 672-2454
Mailing address
1815 S CRISMON RD, 104, MESA, AZ 85209
(480) 672-2453
(480) 672-2454
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1457702607
GENERAL DENTISTRY
AZ
Enumeration date
03/03/2021
Last updated
03/03/2021
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