OrganizationActive
Country Club Dental Management Co, PC
NPI 1164722021 · Dentist · Mesa, AZ
Country Club Dental Management Co, PC is a Dentist organization in Mesa, AZ (NPI 1164722021).
Provider details
- NPI number
- 1164722021
- Entity type
- Organization
- Primary specialty
- DentistDental Providers
- Organization subpart
- No
- Authorized official
- Lawrence Groop, Director(480) 889-9457
- License
- D07819 (AZ)
Specialties & taxonomies
Dental Providers
Dental Providers
Profile Score
Detailed profile(82/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
15 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
4704 E Southern Ave
Suite #1
Mesa, AZ 85206-2737
Phone: (480) 889-9457
Fax: (480) 889-9493
Street-level locationGet directions
Mailing address
4704 E Southern Ave
Mesa, AZ 85206-2737
Registry dates
- Enumerated
- 2010-10-26
- Last updated
- 2013-10-31
Frequently asked questions
- What is Country Club Dental Management Co, PC's NPI number?
- Country Club Dental Management Co, PC's National Provider Identifier (NPI) is 1164722021, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Country Club Dental Management Co, PC?
- Country Club Dental Management Co, PC is classified in the NPPES registry as Dentist (Dental Providers).
- Where is Country Club Dental Management Co, PC located?
- Country Club Dental Management Co, PC's practice location on file with NPPES is 4704 E Southern Ave, Mesa, AZ 85206-2737.
- What is Country Club Dental Management Co, PC's phone number?
- The practice phone number listed in the NPPES registry for Country Club Dental Management Co, PC is (480) 889-9457.
- Who is the authorized official for Country Club Dental Management Co, PC?
- The authorized official listed on Country Club Dental Management Co, PC's NPPES record is Lawrence Groop, Director. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Country Club Dental Management Co, PC's NPI active?
- Yes — Country Club Dental Management Co, PC's NPI (1164722021) is active in the NPPES registry as of the last update on 2013-10-31.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.