Provider Demographics
NPI:1457192783
Name:SONORAN DENTAL STUDIO, PLLC
Entity type:Organization
Organization Name:SONORAN DENTAL STUDIO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:FELIPE
Authorized Official - Last Name:MASCARENAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:623-242-4205
Mailing Address - Street 1:15813 W ALVARADO DR
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-7587
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:865 S WATSON RD STE 201
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-3469
Practice Address - Country:US
Practice Address - Phone:623-242-4205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty