Organization
SDCAZ LLC
Active
Parent organization
SDCAZ LLC
Other names
Paseo Ranch Pediatric Dentistry and Orthodontics
Organization subpart
Yes
Provider details
NPI number
Legal business name
SDCAZ LLC
Authorized official
CASSANDRA WIETH (PAYOR RELATIONS MANAGER)
(623) 267-8121
Entity
Organization
Contact information
Practice address
6677 W THUNDERBIRD RD STE A124, GLENDALE, AZ 85306-3710
(623) 223-9677
Mailing address
6677 W THUNDERBIRD RD STE A124, GLENDALE, AZ 85306-3710
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
—
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
08/08/2024
Last updated
08/08/2024
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