Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.

Country Club Dental Inc

Organization General Practice Dentistry · NPI 1417121880

Country Club Dental Inc provides 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 Not confirmed with CMS for 18 years — call before visiting
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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