Provider Demographics
NPI:1093082679
Name:ARIZONA TMJ AND SLEEP CENTER, LLC
Entity Type:Organization
Organization Name:ARIZONA TMJ AND SLEEP CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:RORY
Authorized Official - Last Name:CHASE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-843-0010
Mailing Address - Street 1:PO BOX 10730
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85318-0730
Mailing Address - Country:US
Mailing Address - Phone:602-843-0010
Mailing Address - Fax:602-843-5554
Practice Address - Street 1:6701 W UNION HILLS DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8067
Practice Address - Country:US
Practice Address - Phone:602-843-0010
Practice Address - Fax:602-843-5554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-25
Last Update Date:2011-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3276122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty