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General NPI Number Information
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NPI Number | 1447976261
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Entity Type | Organization
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Legal Business Name | SDCAZ LLC
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Dates
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Enumeration Date | 10/13/2022
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 524 E BASELINE RD
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City | PHOENIX
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State | AZ
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Zip | 85042-6554
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Country | US
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Telephone | 480-725-0729
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Fax |
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Provider Business Mailing Address
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Address Line | 524 E BASELINE RD
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City | PHOENIX
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State | AZ
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Zip | 85042-6554
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF PAYOR RELATIONS
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Name | CASSANDRA WIETH
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Credential |
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Telephone | 623-267-8121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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