Organization
ON SITE DENTAL, PC
Active
Other names
On Site Dental, New Mexico
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES J. HISRICH DDS (PRESIDENT)
(928) 567-1832
Entity
Organization
Contact information
Practice address
1996 DOUGS PARK RD, CAMP VERDE, AZ 86322
(928) 567-1832
(928) 567-6500
Mailing address
PO BOX 767, CAMP VERDE, AZ 86322-0767
(928) 567-1832
(928) 567-6500
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
723157
—
AZ
05
—
G2381
—
NM
Enumeration date
02/07/2007
Last updated
08/22/2020
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