Provider Demographics
NPI:1619430543
Name:SONORAN VALLEY DENTAL CENTER PLLC
Entity Type:Organization
Organization Name:SONORAN VALLEY DENTAL CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-233-1033
Mailing Address - Street 1:PO BOX 75728
Mailing Address - Street 2:
Mailing Address - City:NEW RIVER
Mailing Address - State:AZ
Mailing Address - Zip Code:85087-1033
Mailing Address - Country:US
Mailing Address - Phone:623-233-1033
Mailing Address - Fax:623-233-1034
Practice Address - Street 1:3719 W ANTHEM WAY STE 101
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-0477
Practice Address - Country:US
Practice Address - Phone:623-233-1033
Practice Address - Fax:623-233-1034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental