Provider Demographics
NPI:1750497723
Name:SONRISA FAMILY DENTISTRY
Entity Type:Organization
Organization Name:SONRISA FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ELDON
Authorized Official - Middle Name:W
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-442-7333
Mailing Address - Street 1:3911 W MCDOWELL
Mailing Address - Street 2:# 15
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85009
Mailing Address - Country:US
Mailing Address - Phone:602-442-7333
Mailing Address - Fax:602-442-7999
Practice Address - Street 1:3911 W MCDOWELL
Practice Address - Street 2:# 15
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85009
Practice Address - Country:US
Practice Address - Phone:602-442-7333
Practice Address - Fax:602-442-7999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD6467122300000X
AZD4206122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty