Provider Demographics
NPI:1346675386
Name:MUGLESTON MACDONALD RACH MODERN DENTISTRY, PC
Entity Type:Organization
Organization Name:MUGLESTON MACDONALD RACH MODERN DENTISTRY, PC
Other - Org Name:MUGLESTON MACDONALD RANCH MODERN DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CODY
Authorized Official - Middle Name:P
Authorized Official - Last Name:MUGLESTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-560-5231
Mailing Address - Street 1:17000 RED HILL AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-5626
Mailing Address - Country:US
Mailing Address - Phone:714-845-8890
Mailing Address - Fax:714-845-8803
Practice Address - Street 1:725 SOUTH GREEN VALLEY PARKWAY SUITE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052
Practice Address - Country:US
Practice Address - Phone:702-560-5231
Practice Address - Fax:702-560-5249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-10
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty