Organization
DENTAL AND BRACES MESA LLC
Active
Organization
DENTAL AND BRACES MESA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LIZ RAMOS (MANAGER)
(602) 714-8203
Entity
Organization
Contact information
Practice address
1245 E SOUTHERN AVE STE 12, MESA, AZ 85204-5138
(480) 636-9970
Mailing address
1515 N GILBERT RD STE 107-131, GILBERT, AZ 85234-2318
(602) 714-8203
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
246754
—
AZ
Enumeration date
01/30/2019
Last updated
01/30/2019
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