Healthcare Provider Details

I. General information

NPI: 1316040934
Provider Name (Legal Business Name): RALPH W PRICE DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 N 32ND ST SUITE 100
PHOENIX AZ
85018
US

IV. Provider business mailing address

4400 N 32ND ST SUITE 100
PHOENIX AZ
85018
US

V. Phone/Fax

Practice location:
  • Phone: 602-956-1114
  • Fax: 602-954-4783
Mailing address:
  • Phone: 602-956-1114
  • Fax: 602-954-4783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number3244
License Number StateAZ

VIII. Authorized Official

Name: DR. RALPH WOODS PRICE
Title or Position: PERIODONTIST
Credential: DDS
Phone: 602-956-1114