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General NPI Number Information
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NPI Number | 1811250301
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Entity Type | Organization
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Legal Business Name | SKYLINE DENTAL GROUP AND ORTHODONTICS, LLP
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Dates
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Enumeration Date | 06/19/2012
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Last Update Date | 12/31/2013
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Provider Practice Location Address
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Address Line | 1714 WEST HUNT HWY SUITE 100
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City | QUEEN CREEK
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State | AZ
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Zip | 85243
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Country | US
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Telephone | 480-882-3119
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Fax | 480-882-3129
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Provider Business Mailing Address
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Address Line | 17000 RED HILL AVE
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City | IRVINE
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State | CA
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Zip | 92614-5626
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Country | US
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Telephone | 714-845-8890
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Fax | 949-474-1495
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Authorized Official
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Title or Position | DMD/OWNER
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Name | JONATHAN RICHTSTEIG
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Credential |
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Telephone | 480-882-3119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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