# SKY DENTAL SOUTHERN

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285320556
- **Authorized official:** ROSA PELAYO (BILLING MNGR)
- **Authorized official phone:** (480) 895-3252

## Contact information

- **Practice address:** 3515 W SOUTHERN AVE STE 152, PHOENIX, AZ 85041-4229
- **Practice address phone:** (602) 268-0006
- **Practice address fax:** (602) 268-0007
- **Mailing address:** 3515 W SOUTHERN AVE STE 152, PHOENIX, AZ 85041-4229
- **Mailing address phone:** (602) 268-0006
- **Mailing address fax:** (602) 268-0007

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 04/11/2023
- **Last updated:** 04/11/2023