Provider Demographics
NPI:1184771339
Name:WSAT ENTERPRISES, LLC
Entity type:Organization
Organization Name:WSAT ENTERPRISES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FAWNE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:PRYOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-944-0073
Mailing Address - Street 1:2323 W MESCAL ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4764
Mailing Address - Country:US
Mailing Address - Phone:602-944-0073
Mailing Address - Fax:602-944-0371
Practice Address - Street 1:5700 W OLIVE AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-3147
Practice Address - Country:US
Practice Address - Phone:623-934-7606
Practice Address - Fax:623-934-0150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD5926122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty