Provider Demographics
NPI:1013064393
Name:DENTAL MASTER DESIGN, PLLC
Entity Type:Organization
Organization Name:DENTAL MASTER DESIGN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:GRIFFITHS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:602-867-4317
Mailing Address - Street 1:PO BOX 10567
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85064-0567
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3420 E SHEA BLVD
Practice Address - Street 2:SUITE 151
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3345
Practice Address - Country:US
Practice Address - Phone:602-867-4317
Practice Address - Fax:602-867-4319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ44801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty