Provider Demographics
NPI:1174098255
Name:DENTAL CARE OF MESA LLC
Entity type:Organization
Organization Name:DENTAL CARE OF MESA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JULEE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIDNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-290-7777
Mailing Address - Street 1:6610 E BASELINE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4441
Mailing Address - Country:US
Mailing Address - Phone:480-290-7777
Mailing Address - Fax:480-290-7776
Practice Address - Street 1:6610 E BASELINE RD
Practice Address - Street 2:STE 104
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4441
Practice Address - Country:US
Practice Address - Phone:480-290-7777
Practice Address - Fax:480-290-7776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty