MEDICARE: DESERT SUN ENDODONTICS PHOENIX LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics

General Provider Information

NPI Number	:	1407533961
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESERT SUN ENDODONTICS PHOENIX LLC

Provider Business Mailing Address
First Line	:	4025 W BELL RD STE 15
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85053-2796
Country	:	US
Telephone Number	:	602-354-3944
Fax Number	:

Provider Business Practice Location Address
First Line	:	4025 W BELL RD STE 15
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85053-2796
Country	:	US
Telephone Number	:	602-354-3944
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING LEAD
Name	:	JENNY GARCIA
Credential	:
Telephone Number	:	972-869-3789

Provider Enumeration Date	:	06/28/2023
Last Update Date	:	07/14/2025

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