Provider Demographics
NPI:1740515691
Name:SUNSET ENDODONTICS, LTD.
Entity type:Organization
Organization Name:SUNSET ENDODONTICS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:JOHNS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:623-878-9090
Mailing Address - Street 1:8632 W CLARA LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-1429
Mailing Address - Country:US
Mailing Address - Phone:623-878-9090
Mailing Address - Fax:623-878-9090
Practice Address - Street 1:8632 W CLARA LN
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-1429
Practice Address - Country:US
Practice Address - Phone:623-878-9090
Practice Address - Fax:623-878-9090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-10
Last Update Date:2009-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD23351223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty