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General NPI Number Information
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NPI Number | 1700245974
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Entity Type | Organization
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Legal Business Name | RAY ROAD DMSO LLC
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Dates
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Enumeration Date | 02/16/2016
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Last Update Date | 11/04/2022
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Provider Practice Location Address
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Address Line | 2900 W RAY RD STE 3
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City | CHANDLER
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State | AZ
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Zip | 85224-7342
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Country | US
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Telephone | 480-393-0687
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Fax |
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Provider Business Mailing Address
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Address Line | 2900 W RAY RD STE 3
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City | CHANDLER
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State | AZ
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Zip | 85224-7342
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Country | US
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Telephone | 480-393-0687
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL
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Name | MS. TRACY H TRAN
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Credential | MPH
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Telephone | 408-234-5099
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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 | 162068
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License Number State | AZ
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