=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013461540
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SARA VIZCARRA DDS PLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2016
-----------------------------------------------------
Last Update Date | 08/13/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10465 E PINNACLE PEAK PKWY SUITE 101
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85255-8099
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-473-8920
-----------------------------------------------------
Fax | 480-473-0615
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10465 E PINNACLE PEAK PKWY SUITE 101
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85255-8099
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-473-8920
-----------------------------------------------------
Fax | 480-473-0615
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DENTIST
-----------------------------------------------------
Name | DR. SARA M. VIZCARRA
-----------------------------------------------------
Credential | D.D.S
-----------------------------------------------------
Telephone | 480-473-8920
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | D6556
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------