Provider Demographics
NPI:1346683950
Name:SONRISA DENTAL, LLC
Entity Type:Organization
Organization Name:SONRISA DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LANY
Authorized Official - Middle Name:
Authorized Official - Last Name:SICALO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-751-7708
Mailing Address - Street 1:9216 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-2416
Mailing Address - Country:US
Mailing Address - Phone:602-466-1213
Mailing Address - Fax:602-466-3874
Practice Address - Street 1:1701 W GLENDALE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-9701
Practice Address - Country:US
Practice Address - Phone:602-466-1213
Practice Address - Fax:602-466-3874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty