Mesa Modern Dentistry, LLP

NPI #1477821460 in Mesa, Arizona

Provider Information

NPI Number: 1477821460
Entity Type: Organization
Organization Name: Mesa Modern Dentistry, LLP
Primary Specialty: Dentist - General Practice
Enumeration Date: Dec 6, 2011
Last Updated: Dec 6, 2011

Practice Location

Address: 3440 E BASELINE RD STE 106
City: Mesa
State: Arizona
ZIP Code: 85204-7247
Phone: (480) 926-2350

Authorized Official

Name: DR. CARL C FAIRCHILD, DDS
Title: OWNER DOCTOR
Phone: (480) 926-2350

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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