Provider Demographics
NPI:1477196327
Name:D & M DENTAL
Entity Type:Organization
Organization Name:D & M DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:GOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:270-792-8644
Mailing Address - Street 1:1619 N DATE DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-1518
Mailing Address - Country:US
Mailing Address - Phone:270-792-8644
Mailing Address - Fax:
Practice Address - Street 1:8390 E VIA DE VENTURA STE F200
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-3177
Practice Address - Country:US
Practice Address - Phone:602-842-5924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental