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NPI Code Detail

MEDICARE: RADIANT DENTAL LLC

MEDICARE: RADIANT DENTAL LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1720748049
Entity Type Code : Organization
Provider Name (Legal Business Name) : RADIANT DENTAL LLC
Provider Business Mailing Address
First Line : 19251 E OASIS DR
Second Line :
City : BLACK CANYON CITY
State : AZ
Zip : 85324-8878
Country : US
Telephone Number : 623-526-2607
Fax Number :
Provider Business Practice Location Address
First Line : 19251 E OASIS DR
Second Line :
City : BLACK CANYON CITY
State : AZ
Zip : 85324-8878
Country : US
Telephone Number : 623-526-2607
Fax Number :
Authorized Official
Title or Position : DIRECTOR OF OPERATIONS
Name : BRENDA LIANA ARMES
Credential :
Telephone Number : 818-577-7367
Provider Enumeration Date : 12/28/2021
Last Update Date : 01/19/2022

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Directions to “RADIANT DENTAL LLC ” Practice Location

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