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General NPI Number Information
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NPI Number | 1972881894
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Entity Type | Organization
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Legal Business Name | RANGER DENTAL
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Dates
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Enumeration Date | 07/26/2011
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Last Update Date | 05/17/2013
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Provider Practice Location Address
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Address Line | 4306 MATLOCK RD STE 116
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City | ARLINGTON
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State | TX
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Zip | 76018-1015
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Country | US
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Telephone | 817-472-6437
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Fax |
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Provider Business Mailing Address
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Address Line | 2411 N HALL ST UNIT #20
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City | DALLAS
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State | TX
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Zip | 75204-2834
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. AARON IP
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Credential | DDS
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Telephone | 979-492-6589
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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 | 22988
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License Number State | TX
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