Provider Demographics
NPI:1013461540
Name:SARA VIZCARRA DDS PLC
Entity Type:Organization
Organization Name:SARA VIZCARRA DDS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:VIZCARRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-473-8920
Mailing Address - Street 1:10465 E PINNACLE PEAK PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-8099
Mailing Address - Country:US
Mailing Address - Phone:480-473-8920
Mailing Address - Fax:480-473-0615
Practice Address - Street 1:10465 E PINNACLE PEAK PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-8099
Practice Address - Country:US
Practice Address - Phone:480-473-8920
Practice Address - Fax:480-473-0615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-13
Last Update Date:2016-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD65561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty