Provider Demographics
NPI:1750468823
Name:DESERT BREEZE FAMILY DENTAL
Entity Type:Organization
Organization Name:DESERT BREEZE FAMILY DENTAL
Other - Org Name:DESERT BREEZE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:SLEZAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-487-4867
Mailing Address - Street 1:5875 LANDERBROOK DRIVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-6502
Mailing Address - Country:US
Mailing Address - Phone:800-487-4867
Mailing Address - Fax:440-995-1012
Practice Address - Street 1:11144 N. FRANK LLOYD BLVD
Practice Address - Street 2:UNIT #E8
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-2646
Practice Address - Country:US
Practice Address - Phone:480-860-9700
Practice Address - Fax:480-860-9750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX184581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty