Provider Demographics
NPI:1609039114
Name:DESERT PALM SURGICAL GROUP
Entity Type:Organization
Organization Name:DESERT PALM SURGICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CABRET-CARLOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DDS
Authorized Official - Phone:480-947-7700
Mailing Address - Street 1:7930 EAST THOMPSON PEAK PARKWAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255
Mailing Address - Country:US
Mailing Address - Phone:480-947-7700
Mailing Address - Fax:480-513-8788
Practice Address - Street 1:7930 EAST THOMPSON PEAK PARKWAY
Practice Address - Street 2:SUITE 101
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255
Practice Address - Country:US
Practice Address - Phone:480-947-7700
Practice Address - Fax:480-513-8788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ56001223S0112X
AZ30196174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty