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General NPI Number Information
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NPI Number | 1760625677
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Entity Type | Organization
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Legal Business Name | SUNRIDGE DENTAL CARE DBA KARL K. WIRTZ, DDS PC
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Dates
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Enumeration Date | 04/08/2009
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Last Update Date | 04/08/2009
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Provider Practice Location Address
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Address Line | 13830 W CAMINO DEL SOL #200
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City | SUN CITY WEST
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State | AZ
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Zip | 85375-4485
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Country | US
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Telephone | 623-544-0700
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Fax | 623-544-0800
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Provider Business Mailing Address
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Address Line | 13830 W CAMINO DEL SOL #200
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City | SUN CITY WEST
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State | AZ
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Zip | 85375-4485
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Country | US
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Telephone | 623-544-0700
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Fax | 623-544-0800
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. KARL K WIRTZ
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Credential | DDS
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Telephone | 623-544-0700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 2315
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License Number State | AZ
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