Healthcare Provider Details

I. General information

NPI: 1740184910
Provider Name (Legal Business Name): CHAUNCEY RANCH DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18325 N ALLIED WAY STE 115
PHOENIX AZ
85054-3107
US

IV. Provider business mailing address

8302 E WILSHIRE DR
SCOTTSDALE AZ
85257-2353
US

V. Phone/Fax

Practice location:
  • Phone: 952-454-5049
  • Fax:
Mailing address:
  • Phone: 952-454-5049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANN KHARRAT
Title or Position: OWNER/DOCTOR
Credential: DMD
Phone: 952-454-5049