Provider Demographics
NPI:1760625677
Name:SUNRIDGE DENTAL CARE DBA KARL K. WIRTZ, DDS PC
Entity Type:Organization
Organization Name:SUNRIDGE DENTAL CARE DBA KARL K. WIRTZ, DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:K
Authorized Official - Last Name:WIRTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-544-0700
Mailing Address - Street 1:13830 W CAMINO DEL SOL
Mailing Address - Street 2:#200
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-4485
Mailing Address - Country:US
Mailing Address - Phone:623-544-0700
Mailing Address - Fax:623-544-0800
Practice Address - Street 1:13830 W CAMINO DEL SOL
Practice Address - Street 2:#200
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-4485
Practice Address - Country:US
Practice Address - Phone:623-544-0700
Practice Address - Fax:623-544-0800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2315261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental