Healthcare Provider Details

I. General information

NPI: 1588577738
Provider Name (Legal Business Name): SKDDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 W NORTHERN AVE STE 109
PHOENIX AZ
85021-5400
US

IV. Provider business mailing address

1717 W NORTHERN AVE STE 109
PHOENIX AZ
85021-5400
US

V. Phone/Fax

Practice location:
  • Phone: 602-861-3700
  • Fax: 602-861-3704
Mailing address:
  • Phone: 602-861-3700
  • Fax: 602-861-3704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: SRI LAKSHMI SILPA KASTALA
Title or Position: OWNER DENTIST
Credential: DDS
Phone: 602-737-9985