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
State | License ID | Taxonomies |
---|---|---|
AZ | 4828 | 261QD0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QD0000X | Ambulatory Health Care Facilities | Clinic/Center | Dental |