Provider Demographics
NPI:1255454104
Name:SUN LAKES FAMILY DENTISTRY,INC.
Entity type:Organization
Organization Name:SUN LAKES FAMILY DENTISTRY,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:ALYSE
Authorized Official - Last Name:DUMONT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-895-1604
Mailing Address - Street 1:10440 E RIGGS RD
Mailing Address - Street 2:SUITE206
Mailing Address - City:SUN LAKES
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-7751
Mailing Address - Country:US
Mailing Address - Phone:480-895-1604
Mailing Address - Fax:
Practice Address - Street 1:10440 E RIGGS RD
Practice Address - Street 2:SUITE206
Practice Address - City:SUN LAKES
Practice Address - State:AZ
Practice Address - Zip Code:85248-7751
Practice Address - Country:US
Practice Address - Phone:480-895-1604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty