Provider Demographics
NPI:1508613563
Name:VIBE DENTAL-MESA
Entity Type:Organization
Organization Name:VIBE DENTAL-MESA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-800-8423
Mailing Address - Street 1:1855 S COUNTRY CLUB DR STE 101
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-6120
Mailing Address - Country:US
Mailing Address - Phone:480-800-8423
Mailing Address - Fax:480-741-8855
Practice Address - Street 1:1855 S COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6037
Practice Address - Country:US
Practice Address - Phone:480-800-8423
Practice Address - Fax:480-741-8855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental