Provider Demographics
NPI:1942014519
Name:DESERT SKY DENTAL PC
Entity type:Organization
Organization Name:DESERT SKY DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:GUNNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-423-0022
Mailing Address - Street 1:26108 S 195TH PL
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-8708
Mailing Address - Country:US
Mailing Address - Phone:520-423-0022
Mailing Address - Fax:
Practice Address - Street 1:1968 N PEART RD STE 11
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-2496
Practice Address - Country:US
Practice Address - Phone:520-423-0022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental