Individual
DR. BLAINE RODNEY COUSER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MS
Contact information
Practice address
4540 E BASELINE RD, SUITE # 104, MESA, AZ 85206-4613
(480) 813-2222
(480) 907-7619
Mailing address
4540 E BASELINE RD, SUITE # 104, MESA, AZ 85206-4613
(480) 813-2222
(480) 907-7619
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
6257
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
963943
AHCCCS PROGRAM NUMBER
AZ
Enumeration date
03/29/2007
Last updated
07/08/2007
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