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General NPI Number Information
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NPI Number | 1417260282
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Entity Type | Organization
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Legal Business Name | SIERRA VISTA ENDODONTICS P.C.
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Dates
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Enumeration Date | 07/21/2010
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Last Update Date | 07/28/2010
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Provider Practice Location Address
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Address Line | 2151 S HWY 92 STE #103
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-5282
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Country | US
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Telephone | 520-417-0311
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Fax |
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Provider Business Mailing Address
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Address Line | 2151 S HWY 92 STE #103
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-5282
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Country | US
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Telephone | 520-417-0311
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. LIBBY A LOWRIE
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Credential |
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Telephone | 520-322-0800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 2999
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License Number State | AZ
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