Provider Demographics
NPI:1134395981
Name:FIESTA DENTAL CARE , P.C.
Entity type:Organization
Organization Name:FIESTA DENTAL CARE , P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:STOJANOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-726-0360
Mailing Address - Street 1:3940 S ALMA SCHOOL RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-4513
Mailing Address - Country:US
Mailing Address - Phone:480-726-0360
Mailing Address - Fax:480-857-0442
Practice Address - Street 1:3940 S ALMA SCHOOL RD
Practice Address - Street 2:SUITE 1
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-4513
Practice Address - Country:US
Practice Address - Phone:480-726-0360
Practice Address - Fax:480-857-0442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty