Provider Demographics
NPI:1952635617
Name:DESERT DENTISTRY, PLLC
Entity Type:Organization
Organization Name:DESERT DENTISTRY, PLLC
Other - Org Name:DESERT DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:MATTERN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-432-0538
Mailing Address - Street 1:6231 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-4236
Mailing Address - Country:US
Mailing Address - Phone:602-268-2273
Mailing Address - Fax:
Practice Address - Street 1:6231 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-4236
Practice Address - Country:US
Practice Address - Phone:602-268-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-29
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty