Provider Demographics
NPI:1508456211
Name:MOUNTAIN SKY FAMILY DENTAL LLC
Entity Type:Organization
Organization Name:MOUNTAIN SKY FAMILY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:GOLDRING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-219-1267
Mailing Address - Street 1:7227 N DREAMY DRAW DR STE 4
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5278
Mailing Address - Country:US
Mailing Address - Phone:623-219-1267
Mailing Address - Fax:
Practice Address - Street 1:7227 N DREAMY DRAW DR STE 4
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5278
Practice Address - Country:US
Practice Address - Phone:623-219-1267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental