Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Country Club Dental Inc

Organization General Practice Dentistry · NPI 1417121880

Country Club Dental Inc is a General Practice Dentistry in Mesa, Arizona. Licensed in Arizona. Registered with an NPI since 2008.

Licensed in
AZ
In the registry since
2008
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

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Practice location Address checks out

3050 S Country Club Dr Ste 18
Mesa, AZ 85210-8365
Phone: (480) 892-8185
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Dentistry (primary) Taxonomy 1223G0001X (AZ)

Record details

NPI number1417121880
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Frances Fattohi — Owner · (480) 892-8185
NPI enumeratedApril 16, 2008
Last updated in NPPESApril 16, 2008
Mailing address3050 S Country Club Dr Ste 18, Mesa, AZ 85210-8365

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