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

Country Club Dental Management Co, PC

Organization Dentist · NPI 1164722021

Country Club Dental Management Co, PC is a Dentist in Mesa, Arizona. Licensed in Arizona. Registered with an NPI since 2010.

Licensed in
AZ
In the registry since
2010
Specialties on file
2
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

4704 E Southern Ave Ste #1
Mesa, AZ 85206-2737
Phone: (480) 889-9457
Fax: (480) 889-9493
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dentist (primary) Taxonomy 122300000X · Licence D07819 (AZ)
General Practice Dentistry Taxonomy 1223G0001X · Licence D07819 (AZ)

Record details

NPI number1164722021
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Lawrence Groop — Director · (480) 889-9457
NPI enumeratedOctober 26, 2010
Last updated in NPPESOctober 31, 2013
Mailing address4704 E Southern Ave, Mesa, AZ 85206-2737

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