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General NPI Number Information
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NPI Number | 1407089717
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Entity Type | Organization
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Legal Business Name | DULGARIAN DENTAL, LLC
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Dates
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Enumeration Date | 09/02/2009
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Last Update Date | 07/27/2015
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Provider Practice Location Address
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Address Line | 912 W CHANDLER BLVD SUITE B3
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City | CHANDLER
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State | AZ
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Zip | 85225-4910
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Country | US
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Telephone | 480-814-1333
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Fax | 480-814-7737
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Provider Business Mailing Address
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Address Line | 912 W CHANDLER BLVD SUITE B3
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City | CHANDLER
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State | AZ
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Zip | 85225-4910
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Country | US
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Telephone | 480-814-1333
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Fax | 480-814-7737
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Authorized Official
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Title or Position | INSURANCE MANAGER
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Name | HARLENE A YBARRA
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Credential | OM
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Telephone | 480-814-1333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 08242
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License Number State | AZ
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