Provider Demographics
NPI:1104008499
Name:SOSSAMAN DENTAL CARE
Entity Type:Organization
Organization Name:SOSSAMAN DENTAL CARE
Other - Org Name:SOSSAMAN DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MORRIE
Authorized Official - Middle Name:ORVILLE
Authorized Official - Last Name:TALBOT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-203-2531
Mailing Address - Street 1:1925 S SOSSAMAN RD STE 212
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-4145
Mailing Address - Country:US
Mailing Address - Phone:480-203-2531
Mailing Address - Fax:
Practice Address - Street 1:1925 S SOSSAMAN RD
Practice Address - Street 2:#212
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-4275
Practice Address - Country:US
Practice Address - Phone:480-203-2531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD62831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty