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General NPI Number Information
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NPI Number | 1073875712
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Entity Type | Organization
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Legal Business Name | ARIZONA DENTAL ANESTHESIOLOGY PLLC
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Dates
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Enumeration Date | 06/08/2012
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Last Update Date | 06/08/2012
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Provider Practice Location Address
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Address Line | 817 E SAN ANGELO AVE
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City | GILBERT
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State | AZ
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Zip | 85234-3513
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Country | US
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Telephone | 480-678-9724
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Fax |
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Provider Business Mailing Address
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Address Line | 817 E SAN ANGELO AVE
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City | GILBERT
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State | AZ
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Zip | 85234-3513
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST ANESTHESIOLOGIST
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Name | SONIA KUMAR
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Credential | DDS
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Telephone | 480-678-9724
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7656
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License Number State | AZ
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