Provider Demographics
NPI:1033650585
Name:VALUE DENTAL CENTERS GOODYEAR AZ, LLC
Entity Type:Organization
Organization Name:VALUE DENTAL CENTERS GOODYEAR AZ, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA/MPH
Authorized Official - Phone:408-626-1755
Mailing Address - Street 1:1100 N ESTRELLA PKWY
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-2808
Mailing Address - Country:US
Mailing Address - Phone:480-626-1755
Mailing Address - Fax:702-842-4323
Practice Address - Street 1:1100 N ESTRELLA PKWY
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-2808
Practice Address - Country:US
Practice Address - Phone:480-626-1755
Practice Address - Fax:702-842-4323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental