Organization
ARIZONA DENTAL SPECIALTY GROUP PLLC
Active
Other names
Children's Dental Land
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID HAASLO DDS (MEMBER)
(602) 626-5437
Entity
Organization
Contact information
Practice address
3722 E THOMAS RD, PHOENIX, AZ 85018-7508
(602) 626-5437
Mailing address
PO BOX 80220, PHOENIX, AZ 85060-0220
(602) 626-5437
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
D5830
AZ
1223P0221X
Pediatric Dentistry
Primary
D5802
AZ
Other
Enumeration date
12/23/2009
Last updated
12/23/2009
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