Provider Demographics
NPI:1346800760
Name:SONORAN SKY FAMILY DENTISTRY
Entity Type:Organization
Organization Name:SONORAN SKY FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:K
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-877-8110
Mailing Address - Street 1:9515 WEST CAMELBACK ROAD
Mailing Address - Street 2:SUITE #120
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037
Mailing Address - Country:US
Mailing Address - Phone:623-877-8710
Mailing Address - Fax:623-877-9339
Practice Address - Street 1:9515 WEST CAMELBACK ROAD
Practice Address - Street 2:SUITE #120
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037
Practice Address - Country:US
Practice Address - Phone:623-877-8710
Practice Address - Fax:623-877-9339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty