# ALTA SKY DENTAL, LLC

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

## Provider details

- **NPI number:** 1396146759
- **Authorized official:** JARED JUSTICE (MEMBER)
- **Authorized official phone:** (858) 208-8451

## Contact information

- **Practice address:** 4303 W PEORIA AVE, SUITE 104, GLENDALE, AZ 85302-2005
- **Practice address phone:** (623) 374-3714
- **Mailing address:** 4303 W PEORIA AVE, SUITE 104, GLENDALE, AZ 85302-2005
- **Mailing address phone:** (623) 374-3714

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 09/04/2014
- **Last updated:** 09/04/2014