Provider Demographics
NPI:1619569415
Name:CONCIERGE DENTAL
Entity Type:Organization
Organization Name:CONCIERGE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:NEISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-201-8210
Mailing Address - Street 1:1846 E INNOVATION PARK DR # 85755
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85755-1963
Mailing Address - Country:US
Mailing Address - Phone:520-201-8210
Mailing Address - Fax:520-318-5701
Practice Address - Street 1:1846 E INNOVATION PARK DR # 85755
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755-1963
Practice Address - Country:US
Practice Address - Phone:520-201-8210
Practice Address - Fax:520-318-5701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty