Healthcare Provider Details

I. General information

NPI: 1700239456
Provider Name (Legal Business Name): DREAMY DRAW SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2016
Last Update Date: 07/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6245 N 16TH ST
PHOENIX AZ
85016-1706
US

IV. Provider business mailing address

10255 N 32ND ST
PHOENIX AZ
85028-3851
US

V. Phone/Fax

Practice location:
  • Phone: 602-393-0661
  • Fax: 602-682-5164
Mailing address:
  • Phone: 602-393-0661
  • Fax: 602-682-5164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KERI M SWEETEN
Title or Position: OWNER
Credential: MD
Phone: 602-393-0661