Provider Demographics
NPI:1164619359
Name:SONORAN CENTER FOR PEDIATRIC DENTISTRY, P.C.
Entity Type:Organization
Organization Name:SONORAN CENTER FOR PEDIATRIC DENTISTRY, P.C.
Other - Org Name:PIMA PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:AUERBACH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-744-2663
Mailing Address - Street 1:2402 E CERRADA DE PROMESA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-3031
Mailing Address - Country:US
Mailing Address - Phone:520-465-2421
Mailing Address - Fax:
Practice Address - Street 1:8567 N SILVERBELL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85743-9513
Practice Address - Country:US
Practice Address - Phone:520-744-2663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30321223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty