Provider Demographics
NPI:1609110915
Name:SIERRA SKY DENTAL LLC
Entity Type:Organization
Organization Name:SIERRA SKY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORENA
Authorized Official - Middle Name:T
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-849-1000
Mailing Address - Street 1:5259 W INDIAN SCHOOL RD.
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85031
Mailing Address - Country:US
Mailing Address - Phone:623-849-1000
Mailing Address - Fax:623-873-7616
Practice Address - Street 1:5259 W INDIAN SCHOOL RD
Practice Address - Street 2:SUITE 110
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-2604
Practice Address - Country:US
Practice Address - Phone:623-849-1000
Practice Address - Fax:623-873-7616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-27
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty