Sun Lakes Periodontics & Implant Dentistry, PLLC

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

6841 Issued in AZ

Legal business name

SUN LAKES PERIODONTICS & IMPLANT DENTISTRY, PLLC

Practice address

10450 E Riggs Rd
Suite #118
Sun Lakes, AZ 85248-7758

Phone

(480) 895-0801

Fax

(480) 895-5927

NPI assigned

Mar 2, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Trever L Siu, DMD, MS

Title

Dentist/Owner

Phone

(480) 895-0801

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1235952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1235952000000",
    "number": "1962642132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10450 E RIGGS RD",
            "address_2": "SUITE #118",
            "city": "SUN LAKES",
            "state": "AZ",
            "postal_code": "852487758",
            "telephone_number": "480-895-0801",
            "fax_number": "480-895-5927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10450 E RIGGS RD",
            "address_2": "SUITE #118",
            "city": "SUN LAKES",
            "state": "AZ",
            "postal_code": "852487758",
            "telephone_number": "480-895-0801",
            "fax_number": "480-895-5927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUN LAKES PERIODONTICS & IMPLANT DENTISTRY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-02",
        "last_updated": "2009-03-02",
        "status": "A",
        "authorized_official_last_name": "SIU",
        "authorized_official_first_name": "TREVER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "480-895-0801",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD, MS"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "AZ",
            "license": "6841",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Periodontics in Sun Lakes, AZ
• Providers in Sun Lakes, AZ by specialty
• Periodontics in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.