Provider Demographics
NPI:1073789814
Name:SUN VALLEY DENTISTRY, INC
Entity Type:Organization
Organization Name:SUN VALLEY DENTISTRY, INC
Other - Org Name:SUN VALLEY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:Q
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:602-248-9445
Mailing Address - Street 1:320 W INDIAN SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3206
Mailing Address - Country:US
Mailing Address - Phone:602-248-9445
Mailing Address - Fax:602-248-9447
Practice Address - Street 1:320 W INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3206
Practice Address - Country:US
Practice Address - Phone:602-248-9445
Practice Address - Fax:602-248-9447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD5978261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental