Organization
HERMOSA DENTAL AND ORTHODONTICS GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RASOUL SALIM (OWNER)
(602) 242-0550
Entity
Organization
Contact information
Practice address
3415 W GLENDALE AVE, 30, PHOENIX, AZ 85051-8386
(602) 242-0550
(602) 242-4965
Mailing address
3415 W GLENDALE AVE, 30, PHOENIX, AZ 85051-8386
(602) 242-0550
(602) 242-4965
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D5067
AZ
1223P0300X
Periodontics
D6876
AZ
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
D8403
AZ
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
D8369
AZ
Other
Enumeration date
12/06/2013
Last updated
12/06/2013
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