MEDICARE: DESERT SANDS MANAGEMENT, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1427184837
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESERT SANDS MANAGEMENT, INC

Provider Business Mailing Address
First Line	:	245 E BELL RD
Second Line	:	SUITE 2
City	:	PHOENIX
State	:	AZ
Zip	:	85022-2353
Country	:	US
Telephone Number	:	602-993-2960
Fax Number	:	602-993-5461

Provider Business Practice Location Address
First Line	:	245 E BELL RD
Second Line	:	SUITE 2
City	:	PHOENIX
State	:	AZ
Zip	:	85022-2353
Country	:	US
Telephone Number	:	602-993-2960
Fax Number	:	602-993-5461

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. JILL HELENE CALEV
Credential	:
Telephone Number	:	602-993-2960

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	08/22/2020

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