MEDICARE: GOLDRING DENTAL & ASSOCIATES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1174115687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDRING DENTAL & ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	5619 E CHARTER OAK RD
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85254-4311
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16421 N TATUM BLVD STE 202
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-3457
Country	:	US
Telephone Number	:	602-992-1639
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF BILLING SERVICES
Name	:	SHERRY LYN CONNELLY
Credential	:
Telephone Number	:	602-687-9430

Provider Enumeration Date	:	02/05/2021
Last Update Date	:	02/05/2021

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