Provider Demographics
NPI:1174414841
Name:SATELITE CO LLC
Entity type:Organization
Organization Name:SATELITE CO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:HERREJON-RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-497-9858
Mailing Address - Street 1:4935 S VAL VISTA DR STE 104
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-0757
Mailing Address - Country:US
Mailing Address - Phone:480-482-7773
Mailing Address - Fax:
Practice Address - Street 1:4935 S VAL VISTA DR STE 104
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-0757
Practice Address - Country:US
Practice Address - Phone:480-482-7773
Practice Address - Fax:480-482-7774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty