Provider Demographics
NPI:1407089717
Name:DULGARIAN DENTAL, LLC
Entity Type:Organization
Organization Name:DULGARIAN DENTAL, LLC
Other - Org Name:SMILES CHANDLER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HARLENE
Authorized Official - Middle Name:A
Authorized Official - Last Name:YBARRA
Authorized Official - Suffix:
Authorized Official - Credentials:OM
Authorized Official - Phone:480-814-1333
Mailing Address - Street 1:912 W CHANDLER BLVD
Mailing Address - Street 2:SUITE B3
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-4910
Mailing Address - Country:US
Mailing Address - Phone:480-814-1333
Mailing Address - Fax:480-814-7737
Practice Address - Street 1:912 W CHANDLER BLVD
Practice Address - Street 2:SUITE B3
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-4910
Practice Address - Country:US
Practice Address - Phone:480-814-1333
Practice Address - Fax:480-814-7737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-02
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ08242122300000X
AZ73051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Yes122300000XDental ProvidersDentistGroup - Single Specialty