Organization
SOUTH MOUNTAIN DENTAL LLC
Active
Other names
South Mountain Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
FAITH GASKINS (DIRECTOR OF CREDENTAILING)
(972) 869-3789
Entity
Organization
Contact information
Practice address
2233 W BASELINE RD STE 104, TEMPE, AZ 85283-1097
(602) 438-9245
Mailing address
2233 W BASELINE RD STE 104, TEMPE, AZ 85283-1097
(602) 438-9245
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
10/18/2021
Last updated
10/18/2021
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