Healthcare Provider Details

I. General information

NPI: 1033478334
Provider Name (Legal Business Name): TEN DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2012
Last Update Date: 05/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1579 N DYSART RD SUITE - F
AVONDALE AZ
85392-1215
US

IV. Provider business mailing address

1579 N DYSART RD SUITE - F
AVONDALE AZ
85392-1215
US

V. Phone/Fax

Practice location:
  • Phone: 623-536-9942
  • Fax: 623-536-7403
Mailing address:
  • Phone: 623-536-9942
  • Fax: 623-536-7403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DOUG CHANG
Title or Position: OWNER/CEO
Credential: DMD
Phone: 623-536-9942