Provider Demographics
NPI:1083893275
Name:TRANQUIL DENTAL CARE, PC
Entity Type:Organization
Organization Name:TRANQUIL DENTAL CARE, PC
Other - Org Name:MISSOURI COMMONS FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:ERWIN
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-248-7868
Mailing Address - Street 1:1440 E MISSOURI AVE
Mailing Address - Street 2:STE 270
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2458
Mailing Address - Country:US
Mailing Address - Phone:602-248-7868
Mailing Address - Fax:602-265-5946
Practice Address - Street 1:1440 E MISSOURI AVE
Practice Address - Street 2:STE 270
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2458
Practice Address - Country:US
Practice Address - Phone:602-248-7868
Practice Address - Fax:602-265-5946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ65551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty