# PUEBLO DEL SOL DENTAL CARE LLC

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

## Provider details

- **NPI number:** 1831613934
- **Authorized official:** DR. JUSTIN M ISRAELSEN DMD (OWNER/MANAGER/DENTIST)
- **Authorized official phone:** (520) 458-2415

## Contact information

- **Practice address:** 1900 PASEO SAN LUIS, SIERRA VISTA, AZ 85635-4614
- **Practice address phone:** (520) 458-2415
- **Practice address fax:** (520) 458-0414
- **Mailing address:** 1900 PASEO SAN LUIS, SIERRA VISTA, AZ 85635-4614
- **Mailing address phone:** (520) 458-2415
- **Mailing address fax:** (520) 458-0414

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D008200 | AZ | Yes |

## Other

- **Enumeration date:** 07/31/2017
- **Last updated:** 07/21/2022