Organization
COUNTRY CLUB DENTAL MANAGEMENT CO, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAWRENCE GEORGE GROOP DMD (DIRECTOR)
(480) 889-9457
Entity
Organization
Contact information
Practice address
4704 E SOUTHERN AVE, SUITE #1, MESA, AZ 85206-2737
(480) 889-9457
(480) 889-9493
Mailing address
4704 E SOUTHERN AVE, MESA, AZ 85206-2737
(480) 889-9457
(480) 889-9493
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D07819
AZ
1223G0001X
General Practice Dentistry
D07819
AZ
Other
Enumeration date
10/26/2010
Last updated
10/31/2013
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