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General NPI Number Information
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NPI Number | 1255615118
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Entity Type | Organization
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Legal Business Name | DESERT VISTA ORTHODONTICS, LLC
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Dates
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Enumeration Date | 10/10/2011
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Last Update Date | 10/10/2011
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Provider Practice Location Address
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Address Line | 2107 PASEO SAN LUIS
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City | SIERRA VISTA
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State | AZ
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Zip | 85635
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Country | US
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Telephone | 520-732-8631
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Fax | 520-459-0113
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Provider Business Mailing Address
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Address Line | 2107 PASEO SAN LUIS
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City | SIERRA VISTA
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State | AZ
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Zip | 85635
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Country | US
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Telephone | 520-732-8631
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Fax | 520-459-0113
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Authorized Official
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Title or Position | OWNER AND DR
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Name | DR. NEAL JONES
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Credential | DDS, MS
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Telephone | 520-732-8631
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D7633
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License Number State | AZ
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