1578910477 NPI number — VALUE DENTAL CENTERS QUEEN CREEK AZ LLC

Table of content: (NPI 1578910477)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578910477 NPI number — VALUE DENTAL CENTERS QUEEN CREEK AZ LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALUE DENTAL CENTERS QUEEN CREEK AZ LLC
Provider Last Name:
Provider First Name:
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Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
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NPI Number Information

NPI Number:
1578910477
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21055 E RITTENHOUSE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
QUEEN CREEK
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85142-4477
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-626-1161
Provider Business Mailing Address Fax Number:
877-395-9470

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21055 E RITTENHOUSE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUEEN CREEK
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85142-4477
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-626-1161
Provider Business Practice Location Address Fax Number:
877-395-9470
Provider Enumeration Date:
05/20/2016

Additional Information

Authorized Official

Authorized Official Last Name:
TRAN
Authorized Official First Name:
TRACY
Authorized Official Middle Name:
H
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
480-626-1161

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  D008977 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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