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General NPI Number Information
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NPI Number | 1245655182
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Entity Type | Organization
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Legal Business Name | ARIZONA DENTAL SLEEP ASSOCIATES, LLC
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Dates
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Enumeration Date | 03/01/2014
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Last Update Date | 11/24/2014
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Provider Practice Location Address
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Address Line | 15715 S 46TH ST SUITE #104
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City | PHOENIX
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State | AZ
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Zip | 85048-0438
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Country | US
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Telephone | 480-598-5900
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Fax |
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Provider Business Mailing Address
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Address Line | 15715 S 46TH ST SUITE #104
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City | PHOENIX
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State | AZ
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Zip | 85048-0438
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Country | US
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Telephone | 480-598-5900
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | DR. DALLIN RICHARD BIRCH
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Credential | D.M.D.
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Telephone | 480-598-5900
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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 | D7605
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License Number State | AZ
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