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Organization

SOH OF ARIZONA SPECIALTY LLC

Active
Other names
Glendale Orthodontics
Organization subpart
No

Provider details

NPI number
Authorized official
ASHLY KRISTINE SUNSHINE (CREDENTIALING SPECIALIST)
(314) 413-2803
Entity
Organization

Contact information

Practice address
6120 W BELL RD STE 190, GLENDALE, AZ 85308-3786
(602) 485-4700
Mailing address
1422 ELBRIDGE PAYNE RD STE 240, CHESTERFIELD, MO 63017-8544
(636) 362-4986

Taxonomy

Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary

Other

Enumeration date
08/09/2022
Last updated
04/20/2023
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