STEPHEN VITAL DMD INC
Managed Care Organizations at Brown Rd, Mesa, AZ

License number
Arizona 3270
Category
Managed Care Organizations
Type
Preferred Provider Organization
Owner
Name: DR. STEPHEN J VITAL DMD
Title: PRESIDENT
Phone: (480) 924-6169
Address
Address
3505 E Brown Rd SUITE 102, Mesa, AZ 85213
National Provider ID: 1619134079
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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STEPHEN VITAL D.M.D., INC

3505 E Brown Rd #102, Mesa, AZ 85213

Registration:
Mar 8, 2002
State ID:
-1021951-4
Expiration:
PERPETUAL
President:
Stephen Vital (President), 3505 E Brown Rd #102, Mesa, AZ 85213 (Physical)
Agent:
Deborah Timmons,34348 N Damietta Trl, San Tan Valley, AZ 85143 (Physical)
Business type:
HEALTH CARE

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