Organization
SUN VALLEY PEDIATRIC DENTISTRY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAIME JOHNSON (CONTROLLER)
(480) 889-9457
Entity
Organization
Contact information
Practice address
10750 W MCDOWELL RD, SUITE F-610, AVONDALE, AZ 85392-5960
(622) 347-4290
(623) 474-2905
Mailing address
4704 E SOUTHERN AVE, DEPT AVON, MESA, AZ 85206-2737
(480) 889-9457
(480) 696-5505
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
05/29/2015
Last updated
05/29/2015
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