Provider Demographics
NPI:1912883695
Name:AZ SDS III LLC
Entity type:Organization
Organization Name:AZ SDS III LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:V
Authorized Official - Last Name:DASCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-638-0303
Mailing Address - Street 1:1610 54TH AVE N STE 205
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-1442
Mailing Address - Country:US
Mailing Address - Phone:504-638-0303
Mailing Address - Fax:
Practice Address - Street 1:10006 W HAPPY VALLEY PKWY STE 1220
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-1238
Practice Address - Country:US
Practice Address - Phone:623-486-3377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AZ SDS III LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty