Provider Demographics
NPI:1326879842
Name:SDCAZ LLC
Entity type:Organization
Organization Name:SDCAZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PAYOR RELATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WIETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-267-8121
Mailing Address - Street 1:6677 W THUNDERBIRD RD STE A124
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-3710
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6677 W THUNDERBIRD RD STE A124
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-3710
Practice Address - Country:US
Practice Address - Phone:623-223-9677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SDCAZ LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty