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General NPI Number Information
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NPI Number | 1740515691
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Entity Type | Organization
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Legal Business Name | SUNSET ENDODONTICS, LTD.
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Dates
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Enumeration Date | 10/10/2009
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Last Update Date | 10/10/2009
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Provider Practice Location Address
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Address Line | 8632 W CLARA LN
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City | PEORIA
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State | AZ
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Zip | 85382-1429
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Country | US
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Telephone | 623-878-9090
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Fax | 623-878-9090
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Provider Business Mailing Address
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Address Line | 8632 W CLARA LN
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City | PEORIA
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State | AZ
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Zip | 85382-1429
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Country | US
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Telephone | 623-878-9090
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Fax | 623-878-9090
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LAURENCE DOUGLAS JOHNS
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Credential | D.D.S, M.S.D.
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Telephone | 623-878-9090
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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 | D2335
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License Number State | AZ
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