Provider Demographics
NPI:1245412287
Name:DESERT SKY FAMILY DENTAL PLLC
Entity Type:Organization
Organization Name:DESERT SKY FAMILY DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:602-570-9667
Mailing Address - Street 1:7620 W THOMAS RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85033-5434
Mailing Address - Country:US
Mailing Address - Phone:602-570-9667
Mailing Address - Fax:
Practice Address - Street 1:7620 W THOMAS RD
Practice Address - Street 2:SUITE 102
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033-5434
Practice Address - Country:US
Practice Address - Phone:602-570-9667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-01
Last Update Date:2007-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ61071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty