Healthcare Provider Details

I. General information

NPI: 1457553166
Provider Name (Legal Business Name): SONORA DENTAL GROUP MULTI SPECIALTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 N 19TH AVE SUIT 305
PHOENIX AZ
85015-2450
US

IV. Provider business mailing address

5501 N 19TH AVE SUIT 305
PHOENIX AZ
85015-2450
US

V. Phone/Fax

Practice location:
  • Phone: 602-544-2239
  • Fax: 602-544-3025
Mailing address:
  • Phone: 602-544-2239
  • Fax: 602-544-3025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: MR. BENZAD SOLYMANI
Title or Position: CEO
Credential:
Phone: 602-544-2239