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General NPI Number Information
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NPI Number | 1821305798
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Entity Type | Organization
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Legal Business Name | RANCHO SANTA FE DENTAL GROUP
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Dates
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Enumeration Date | 09/13/2010
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Last Update Date | 04/29/2011
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Provider Practice Location Address
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Address Line | 13048 W RANCHO SANTA FE BLVD 114
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City | AVONDALE
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State | AZ
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Zip | 85392-1705
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Country | US
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Telephone | 623-536-3377
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Fax | 623-536-3088
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Provider Business Mailing Address
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Address Line | 13048 W RANCHO SANTA FE BLVD 114
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City | AVONDALE
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State | AZ
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Zip | 85392-1705
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Country | US
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Telephone | 623-536-3377
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MY-ANH T TRAN
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Credential | DMD
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Telephone | 623-536-3377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D6970
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License Number State | AZ
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