MEDICARE: RED ROCK FAMILY DENTISTRY, LTD.

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	1223G0001X	General Practice Dentistry	4668	AZ

General Provider Information

NPI Number	:	1649391293
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RED ROCK FAMILY DENTISTRY, LTD.

Provider Business Mailing Address
First Line	:	908 W CHANDLER BLVD
Second Line	:	STE. C-7
City	:	CHANDLER
State	:	AZ
Zip	:	85225-2548
Country	:	US
Telephone Number	:	480-782-8111
Fax Number	:	480-857-2609

Provider Business Practice Location Address
First Line	:	908 W CHANDLER BLVD
Second Line	:	STE. C-7
City	:	CHANDLER
State	:	AZ
Zip	:	85225-2548
Country	:	US
Telephone Number	:	480-782-8111
Fax Number	:	480-857-2609

Authorized Official
Title or Position	:	TREASURER
Name	:	DR. RANDY SCOTT CULLIMORE
Credential	:	DDS
Telephone Number	:	480-782-8111

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	08/22/2020

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