Country Club Dental Inc.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

COUNTRY CLUB DENTAL INC.

Practice address

3050 S Country Club Dr Ste 18
Mesa, AZ 85210-8365

Phone

(480) 892-8185

NPI assigned

Apr 16, 2008

Last updated

Apr 16, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Frances Joann Fattohi

Title

Owner

Phone

(480) 892-8185

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Neil S. Reiser, DDS

  • General Practice Dentistry
  • Mesa, AZ
  • NPI 1205924214
  NPD (past)
• Farshad Rouhani, DMD

  • Dentist
  • Scottsdale, AZ
  • NPI 1790127744
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1208304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208304000000",
    "number": "1417121880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3050 S COUNTRY CLUB DR STE 18",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852108365",
            "telephone_number": "480-892-8185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3050 S COUNTRY CLUB DR STE 18",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852108365",
            "telephone_number": "480-892-8185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY CLUB DENTAL INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-16",
        "last_updated": "2008-04-16",
        "status": "A",
        "authorized_official_last_name": "FATTOHI",
        "authorized_official_first_name": "FRANCES",
        "authorized_official_middle_name": "JOANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-892-8185"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Drew Michael Cotton
• Daniel Couch, NP
• Natalie Couch
• Ashley Farrell Coughlin, MD
• Country Club Chiropractic LLC
• Country Club Dental Management Co, PC
• Country Club Medical Group P C (Southeast Valley Medical Group)
• Country Club Medical Weight Loss & Wellness PLLC
• Country Oaks
• Cherise Courtright

• General Practice Dentistry in Mesa, AZ
• Providers in Mesa, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.