Provider Demographics
NPI:1558701698
Name:MFDO LLC
Entity Type:Organization
Organization Name:MFDO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEXTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-941-8983
Mailing Address - Street 1:44480 W HONEYCUTT RD
Mailing Address - Street 2:STE 110
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-2903
Mailing Address - Country:US
Mailing Address - Phone:520-568-9100
Mailing Address - Fax:520-568-9190
Practice Address - Street 1:44480 W HONEYCUTT RD
Practice Address - Street 2:STE 110
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-2903
Practice Address - Country:US
Practice Address - Phone:520-568-9100
Practice Address - Fax:520-568-9190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty