Organization
EAST VALLEY IMPLANT AND PERIODONTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE COLE (VP INSURANCE PLAN MANAGEMENT)
(941) 955-3150
Entity
Organization
Contact information
Practice address
3048 E BASELINE RD STE 112, MESA, AZ 85204-7287
(480) 376-2848
Mailing address
8952 E DESERT COVE AVE # D101, SCOTTSDALE, AZ 85260-6775
(480) 376-2848
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Enumeration date
09/10/2019
Last updated
09/10/2019
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