Provider Demographics
NPI:1871234336
Name:MY TIME DENTAL CENTERS
Entity Type:Organization
Organization Name:MY TIME DENTAL CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMELTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-909-4255
Mailing Address - Street 1:1941 W GUADALUPE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-7484
Mailing Address - Country:US
Mailing Address - Phone:480-909-4255
Mailing Address - Fax:
Practice Address - Street 1:1941 W GUADALUPE RD STE 120
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-7484
Practice Address - Country:US
Practice Address - Phone:480-909-4255
Practice Address - Fax:334-339-7349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty