Healthcare Provider Details

I. General information

NPI: 1184568974
Provider Name (Legal Business Name): REJUVEDENT GROVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4280 E CAMELBACK RD STE 100
PHOENIX AZ
85018-2751
US

IV. Provider business mailing address

5000 N CAMELBACK RIDGE DR UNIT 202
SCOTTSDALE AZ
85251-3433
US

V. Phone/Fax

Practice location:
  • Phone: 480-919-7358
  • Fax:
Mailing address:
  • Phone: 415-609-7158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: MS. TINA TRAN
Title or Position: CEO
Credential:
Phone: 415-609-7158