Organization
BANNER DESERT SURGERY CENTER LP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENNIS E DAHLEN (SR VICE PRESIDENT FINANCE)
(602) 747-4000
Entity
Organization
Contact information
Practice address
1500 S DOBSON RD STE 101, MESA, AZ 85202-4722
(480) 512-3590
Mailing address
1441 N 12TH ST, PHOENIX, AZ 85006-2837
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
OSC 3780
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
957706
—
AZ
Enumeration date
06/19/2006
Last updated
04/12/2013
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