Organization
MESA DENTAL ARIZONA LLC
Active
Parent organization
MESA DENTAL ARIZONA LLC
Other names
Southern Dental
Organization subpart
Yes
Provider details
NPI number
Legal business name
MESA DENTAL ARIZONA LLC
Authorized official
MR. MARK WILKES MORRIS DMD (SOLE OWNER/GENERAL DENTIST)
(312) 339-0588
Entity
Organization
Contact information
Practice address
3320 W SOUTHERN AVE #111, PHOENIX, AZ 85041
(602) 305-8800
Mailing address
1 EAST WASHINGTON ST STE 500, PHOENIX, AZ 85004
(480) 696-1095
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
9690
AZ
Other
Enumeration date
06/14/2017
Last updated
06/14/2017
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