Organization
KIDS DENTAL GROUP PLLC
Active
Other names
Mesa Pediatric Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL PONCE DDS (OWNER)
(646) 234-6578
Entity
Organization
Contact information
Practice address
6239 E BROWN RD STE 102, MESA, AZ 85205-4933
(480) 396-3660
Mailing address
6025 N 27TH AVE STE 25, PHOENIX, AZ 85017-1765
(602) 595-9199
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
04/24/2018
Last updated
04/24/2018
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