Organization
MESA KIDTASTIC DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FAITH GASKINS (DIRECTOR OF CREDENTIALING)
(972) 869-3789
Entity
Organization
Contact information
Practice address
1240 W SOUTHERN AVE STE 112, MESA, AZ 85202-4882
(403) 733-5437
Mailing address
1240 W SOUTHERN AVE STE 112, MESA, AZ 85202-4882
(403) 733-5437
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
10/03/2019
Last updated
10/03/2019
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