Provider Demographics
NPI:1295558344
Name:SUNRISE MOUNTAIN DENTAL AND ORTHODONTICS
Entity type:Organization
Organization Name:SUNRISE MOUNTAIN DENTAL AND ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DUSTI
Authorized Official - Middle Name:
Authorized Official - Last Name:FARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-628-0511
Mailing Address - Street 1:772 N DIXIE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-7444
Mailing Address - Country:US
Mailing Address - Phone:435-628-0511
Mailing Address - Fax:
Practice Address - Street 1:256 E LAKE MEAD PKWY STE C
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-5585
Practice Address - Country:US
Practice Address - Phone:702-703-5410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental