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General NPI Number Information
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NPI Number | 1295558344
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Entity Type | Organization
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Legal Business Name | SUNRISE MOUNTAIN DENTAL AND ORTHODONTICS
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Dates
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Enumeration Date | 11/06/2024
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 256 E LAKE MEAD PKWY STE C
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City | HENDERSON
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State | NV
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Zip | 89015-5585
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Country | US
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Telephone | 702-703-5410
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Fax |
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Provider Business Mailing Address
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Address Line | 772 N DIXIE DR STE 101
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City | ST GEORGE
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State | UT
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Zip | 84770-7444
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Country | US
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Telephone | 435-628-0511
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DUSTI FARR
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Credential |
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Telephone | 435-628-0511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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