Provider Demographics
NPI:1194240929
Name:SEDONA DENTISTRY
Entity type:Organization
Organization Name:SEDONA DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST / BUSINESS PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:PLOURDE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:602-615-3269
Mailing Address - Street 1:1785 W HIGHWAY 89A STE 3G
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-5577
Mailing Address - Country:US
Mailing Address - Phone:928-282-9414
Mailing Address - Fax:
Practice Address - Street 1:1785 W HIGHWAY 89A STE 3G
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-5577
Practice Address - Country:US
Practice Address - Phone:928-282-9414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0097371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty