Provider Demographics
NPI:1396003448
Name:MEGUMI MANAGEMENT LLC
Entity Type:Organization
Organization Name:MEGUMI MANAGEMENT LLC
Other - Org Name:WESTBROOK VILLAGE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:RDH, MBA
Authorized Official - Phone:480-231-7020
Mailing Address - Street 1:8639 W UNION HILLS DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-7000
Mailing Address - Country:US
Mailing Address - Phone:623-876-1777
Mailing Address - Fax:623-974-4974
Practice Address - Street 1:8639 W UNION HILLS DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-7000
Practice Address - Country:US
Practice Address - Phone:623-876-1777
Practice Address - Fax:623-974-4974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty