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General NPI Number Information
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NPI Number | 1669358347
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Entity Type | Organization
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Legal Business Name | AZ SDS III LLC
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Dates
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Enumeration Date | 08/15/2025
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Last Update Date | 08/15/2025
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Provider Practice Location Address
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Address Line | 3549 E BROWN RD STE 102
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City | MESA
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State | AZ
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Zip | 85213-5606
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Country | US
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Telephone | 480-634-5686
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Fax |
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Provider Business Mailing Address
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Address Line | 1610 54TH AVE N STE 205
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City | NASHVILLE
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State | TN
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Zip | 37209-1442
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Country | US
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Telephone | 504-638-0303
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Fax |
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Authorized Official
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Title or Position | SR DIRECTOR OF CREDENTIALING
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Name | CHARLOTTE V DASCH
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Credential |
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Telephone | 504-638-0303
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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 |
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License Number State |
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Taxonomy #2
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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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