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General NPI Number Information
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NPI Number | 1578910477
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Entity Type | Organization
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Legal Business Name | VALUE DENTAL CENTERS QUEEN CREEK AZ LLC
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Dates
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Enumeration Date | 05/20/2016
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Last Update Date | 12/08/2016
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Provider Practice Location Address
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Address Line | 21055 E RITTENHOUSE RD
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-4477
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Country | US
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Telephone | 480-626-1161
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Fax | 877-395-9470
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Provider Business Mailing Address
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Address Line | 21055 E RITTENHOUSE RD
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-4477
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Country | US
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Telephone | 480-626-1161
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Fax | 877-395-9470
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. TRACY H TRAN
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Credential | MBA/MPH
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Telephone | 480-626-1161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | D008977
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License Number State | AZ
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