Provider Demographics
NPI:1689874323
Name:ARIZONA DENTAL DESIGN
Entity Type:Organization
Organization Name:ARIZONA DENTAL DESIGN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-730-6888
Mailing Address - Street 1:4940 W. RAY ROAD SUITE 8
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226
Mailing Address - Country:US
Mailing Address - Phone:480-730-6888
Mailing Address - Fax:480-730-8555
Practice Address - Street 1:4940 W. RAY ROAD SUITE 8
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226
Practice Address - Country:US
Practice Address - Phone:480-730-6888
Practice Address - Fax:480-730-8555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL44201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty