Organization
MAHALO DENTAL GROUP LLC
Active
Parent organization
EL MIRAGE DENTAL EXCELLENCE
Other names
El Mirage Dental Excellence
Organization subpart
Yes
Provider details
NPI number
Legal business name
EL MIRAGE DENTAL EXCELLENCE
Authorized official
DR. DAN NYDEGGER DDS (OWNER)
(623) 882-1400
Entity
Organization
Contact information
Practice address
10111 N EL MIRAGE RD, SUITE #4, EL MIRAGE, AZ 85335-3605
(623) 882-1540
(623) 882-1300
Mailing address
10111 N EL MIRAGE RD, SUITE #4, EL MIRAGE, AZ 85335-3605
(623) 882-1540
(623) 882-1300
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D5540
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6196645
—
AZ
Enumeration date
02/26/2015
Last updated
02/26/2015
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