Country Club Dental Management Co, PC
NPI 1164722021ActiveOrganization· Dentist· Mesa, AZ
Dentist in Mesa, Arizona, registered in NPPES in October 2010. The authorized official on file is Lawrence George Groop, DMD, Director.
Overview
| NPI | 1164722021 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Oct 26, 2010 |
| Last updated in NPPES | Oct 31, 2013 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dentist Primary | 122300000X | D07819 | AZ |
| Dentist, General Practice | 1223G0001X | D07819 | AZ |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
Other Dentist providers in Mesa
- 1023102183
- 1285845776
- 1033587571
- 1245465020
- 1316423353
- 1104955509
- 1942552104
- 1679463723
- 1861632614
- 1659778637
- 1770609000
- 1457267734