Provider Demographics
NPI:1033520671
Name:SK DENTAL LLC
Entity Type:Organization
Organization Name:SK DENTAL LLC
Other - Org Name:PROTECTION PLUS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DHANJAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-251-4346
Mailing Address - Street 1:15288 W BROOKSIDE LN
Mailing Address - Street 2:BUILDING D SUITE 131
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-3990
Mailing Address - Country:US
Mailing Address - Phone:623-251-4346
Mailing Address - Fax:623-251-4767
Practice Address - Street 1:15288 W BROOKSIDE LN
Practice Address - Street 2:BUILDING D SUITE 131
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3990
Practice Address - Country:US
Practice Address - Phone:623-251-4346
Practice Address - Fax:623-251-4767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD06987261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ735948Medicaid