Provider Demographics
NPI:1366642464
Name:SIERRA DENTAL, P.C.
Entity Type:Organization
Organization Name:SIERRA DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GERMAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIERRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:928-536-7158
Mailing Address - Street 1:PO BOX 780
Mailing Address - Street 2:
Mailing Address - City:SNOWFLAKE
Mailing Address - State:AZ
Mailing Address - Zip Code:85937-0780
Mailing Address - Country:US
Mailing Address - Phone:928-536-7158
Mailing Address - Fax:928-536-2640
Practice Address - Street 1:155 W CENTER ST
Practice Address - Street 2:
Practice Address - City:SNOWFLAKE
Practice Address - State:AZ
Practice Address - Zip Code:85937-5211
Practice Address - Country:US
Practice Address - Phone:928-536-7158
Practice Address - Fax:928-536-2640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4607122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty