Provider Demographics
NPI:1124394515
Name:SFJG HOLDINGS LLC
Entity Type:Organization
Organization Name:SFJG HOLDINGS LLC
Other - Org Name:DBA DEER VALLEY SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGOR
Authorized Official - Prefix:
Authorized Official - First Name:TAROLL
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRAZIANO
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:623-434-0620
Mailing Address - Street 1:3414 W. UNION HILLS DR SUITE 8
Mailing Address - Street 2:SUITE H
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027
Mailing Address - Country:US
Mailing Address - Phone:623-434-0620
Mailing Address - Fax:623-236-9360
Practice Address - Street 1:3414 W. UNION HILLS DR
Practice Address - Street 2:SUITE 12 & 14
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027
Practice Address - Country:US
Practice Address - Phone:623-434-0620
Practice Address - Fax:623-434-0619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty