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General NPI Number Information
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NPI Number | 1316017288
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Entity Type | Organization
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Legal Business Name | SIERRA VISTA DENTAL
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4990 E. MEDITERRANEAN DR. SUITE A
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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 | 520-459-3067
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Fax | 520-459-0113
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Provider Business Mailing Address
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Address Line | 4990 E. MEDITERRANEAN DR. SUITE A
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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 | 520-459-3067
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Fax | 520-459-0113
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. JARED W HAWS
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Credential | D.D.S.
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Telephone | 520-459-3067
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D5931
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D7219
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D5877
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License Number State | AZ
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