Healthcare Provider Details

I. General information

NPI: 1629228754
Provider Name (Legal Business Name): JOHN JOSEPH SESTA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2008
Last Update Date: 09/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15033 W BELL RD SUITE 100
SURPRISE AZ
85374-3217
US

IV. Provider business mailing address

12729 W SAN MIGUEL AVE
LITCHFIELD PARK AZ
85340-4103
US

V. Phone/Fax

Practice location:
  • Phone: 623-537-9100
  • Fax: 623-518-3168
Mailing address:
  • Phone: 623-986-6174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4755
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: