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General NPI Number Information
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NPI Number | 1881074318
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Entity Type | Organization
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Legal Business Name | SUN VALLEY PEDIATRIC DENTISTRY, PLLC
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Dates
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Enumeration Date | 05/29/2015
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Last Update Date | 05/29/2015
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Provider Practice Location Address
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Address Line | 10750 W MCDOWELL RD SUITE F-610
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City | AVONDALE
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State | AZ
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Zip | 85392-5960
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Country | US
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Telephone | 622-347-4290
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Fax | 623-474-2905
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Provider Business Mailing Address
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Address Line | 4704 E SOUTHERN AVE DEPT AVON
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City | MESA
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State | AZ
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Zip | 85206-2737
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Country | US
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Telephone | 480-889-9457
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Fax | 480-696-5505
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Authorized Official
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Title or Position | CONTROLLER
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Name | JAIME JOHNSON
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Credential |
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Telephone | 480-889-9457
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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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