Provider Demographics
NPI:1063635985
Name:MOON PAYNE MANAGEMENT LLP
Entity Type:Organization
Organization Name:MOON PAYNE MANAGEMENT LLP
Other - Org Name:AZ DENTAL SPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRAGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-222-8083
Mailing Address - Street 1:3930 S ALMA SCHOOL RD
Mailing Address - Street 2:BLDG. B, STE. 6
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-4510
Mailing Address - Country:US
Mailing Address - Phone:480-222-8083
Mailing Address - Fax:480-222-8084
Practice Address - Street 1:3930 S ALMA SCHOOL RD
Practice Address - Street 2:BLDG. B, STE. 6
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-4510
Practice Address - Country:US
Practice Address - Phone:480-222-8083
Practice Address - Fax:480-222-8084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD51441223G0001X
AZD51361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty