Organization
AZ SDS III LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLOTTE DASCH (SR DIRECTOR OF CREDENTIALING)
(504) 638-0303
Entity
Organization
Contact information
Practice address
4232 E CHANDLER BLVD STE 10, PHOENIX, AZ 85048-8879
(480) 759-1119
Mailing address
1610 54TH AVE N STE 205, NASHVILLE, TN 37209-1442
(504) 638-0303
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
08/15/2025
Last updated
08/15/2025
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