1801 Southern Vista Dental Care

NPI 1023102183 - Dentist - 122300000X

NPI Details
NPI 1023102183
Enumeration Date 10/03/2006
Last Updated 07/08/2007
Entity Type Healthcare Provider
Active Over 11 years ago
Authorized Information
Name ELWYNN CHAD ELWYNN
Position DIRECT OWNER
Phone (480) 892-9000
Fax (480) 926-0545
Practice Location
1801 E SOUTHERN AVE
SUITE 103
MESA AZ, 85204-5258, US
Phone (480) 892-9000
Fax (480) 926-0545
Business Location
1801 E SOUTHERN AVE
SUITE 103
MESA AZ, 85204-5258, US
Phone (480) 892-9000
Fax (480) 926-0545
Toxanomy
Taxonomy Code 122300000X
License State Arizona
License Number 6283
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According to our database, 1801 Southern Vista Dental Care NPI is 1023102183, taxonomy code is 122300000X and license number is 6283, license state is located at Arizona. 1801 Southern Vista Dental Care physically located at 1801 E Southern Ave, Mesa AZ, 85204-5258. NPI Number 1033115704 has the healthcare provider type.

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1023102183 NPI number is provided on an as is basis without warranty of any kind. 1023102183 is maintained by the National Plan & Provider Enumeration System. The contents of 1801 Southern Vista Dental Care are for informational purposes only.