Provider Demographics
NPI:1245655182
Name:ARIZONA DENTAL SLEEP ASSOCIATES, LLC
Entity type:Organization
Organization Name:ARIZONA DENTAL SLEEP ASSOCIATES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DALLIN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:BIRCH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:480-598-5900
Mailing Address - Street 1:15715 S 46TH ST
Mailing Address - Street 2:SUITE #104
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-0438
Mailing Address - Country:US
Mailing Address - Phone:480-598-5900
Mailing Address - Fax:
Practice Address - Street 1:15715 S 46TH ST
Practice Address - Street 2:SUITE #104
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-0438
Practice Address - Country:US
Practice Address - Phone:480-598-5900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-01
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD7605122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty