Healthcare Provider Details

I. General information

NPI: 1770801672
Provider Name (Legal Business Name): SUN CITY DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2010
Last Update Date: 05/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10147 GRAND AVE SUITE B-2
SUN CITY AZ
85351-3435
US

IV. Provider business mailing address

10147 GRAND AVE SUITE B-2
SUN CITY AZ
85351-3435
US

V. Phone/Fax

Practice location:
  • Phone: 623-933-1874
  • Fax: 623-933-0636
Mailing address:
  • Phone: 623-933-1874
  • Fax: 623-933-0636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateAZ

VIII. Authorized Official

Name: JOSEPH HE CHANG
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 623-584-0733