Provider Demographics
NPI:1417260282
Name:SIERRA VISTA ENDODONTICS P.C.
Entity Type:Organization
Organization Name:SIERRA VISTA ENDODONTICS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIBBY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOWRIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-322-0800
Mailing Address - Street 1:2151 S HWY 92
Mailing Address - Street 2:STE #103
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-5282
Mailing Address - Country:US
Mailing Address - Phone:520-417-0311
Mailing Address - Fax:
Practice Address - Street 1:2151 S HWY 92
Practice Address - Street 2:STE #103
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-5282
Practice Address - Country:US
Practice Address - Phone:520-417-0311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-21
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29991223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty