Provider Demographics
NPI:1669658126
Name:DENTISTRY AT HAYDEN PEAK LLC
Entity Type:Organization
Organization Name:DENTISTRY AT HAYDEN PEAK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:CHEN
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-994-5555
Mailing Address - Street 1:8300 E DIXILETA DR
Mailing Address - Street 2:UNIT 229
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85266-2273
Mailing Address - Country:US
Mailing Address - Phone:480-994-5555
Mailing Address - Fax:480-575-0222
Practice Address - Street 1:20511 N HAYDEN RD
Practice Address - Street 2:SUITE 150
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-3877
Practice Address - Country:US
Practice Address - Phone:480-994-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4828261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental