Organization
KS AZ-2, PC
Active
Other names
Manzana Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DALE MAYFIELD DMD (PRESIDENT)
(770) 916-5036
Entity
Organization
Contact information
Practice address
2383 WEST 24TH STREET, YUMA, AZ 85364
(928) 314-1131
(928) 314-1132
Mailing address
1090 NORTHCHASE PKWY SE STE 150, MARIETTA, GA 30067-6407
(770) 916-5028
(678) 247-7858
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
Other
Enumeration date
10/06/2006
Last updated
08/29/2018
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