Healthcare Provider Details

I. General information

NPI: 1881281889
Provider Name (Legal Business Name): TS DENTAL MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2020
Last Update Date: 12/28/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4530 E RAY RD STE 170
PHOENIX AZ
85044-6097
US

IV. Provider business mailing address

4530 E RAY RD STE 170
PHOENIX AZ
85044-6097
US

V. Phone/Fax

Practice location:
  • Phone: 480-477-3090
  • Fax:
Mailing address:
  • Phone: 480-477-3090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateNULL

VIII. Authorized Official

Name: TRACY TRAN
Title or Position: MANAGER
Credential:
Phone: 480-477-3090