Provider Demographics
NPI:1639723687
Name:WELLBEING DENTAL
Entity Type:Organization
Organization Name:WELLBEING DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KARLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-757-7777
Mailing Address - Street 1:1731 W BASELINE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-5730
Mailing Address - Country:US
Mailing Address - Phone:480-757-7777
Mailing Address - Fax:480-656-2888
Practice Address - Street 1:1731 W BASELINE RD STE 104
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-5730
Practice Address - Country:US
Practice Address - Phone:480-757-7777
Practice Address - Fax:480-656-2888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-29
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1235119785Medicaid