# SIERRA VISTA DENTAL

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

## Provider details

- **NPI number:** 1316017288
- **Authorized official:** DR. JARED W HAWS D.D.S. (GENERAL DENTIST)
- **Authorized official phone:** (520) 459-3067

## Contact information

- **Practice address:** 4990 E. MEDITERRANEAN DR., SUITE A, SIERRA VISTA, AZ 85635
- **Practice address phone:** (520) 459-3067
- **Practice address fax:** (520) 459-0113
- **Mailing address:** 4990 E. MEDITERRANEAN DR., SUITE A, SIERRA VISTA, AZ 85635
- **Mailing address phone:** (520) 459-3067
- **Mailing address fax:** (520) 459-0113

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D5877 | AZ | Yes |
| 1223G0001X | General Practice Dentistry | D5931 | AZ | — |
| 1223G0001X | General Practice Dentistry | D7219 | AZ | — |

## Other

- **Enumeration date:** 11/08/2006
- **Last updated:** 08/22/2020