Provider Demographics
NPI:1568063329
Name:TROMBETTA DENTAL SOLUTIONS
Entity Type:Organization
Organization Name:TROMBETTA DENTAL SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:TEAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-616-0790
Mailing Address - Street 1:13808 N SANDARIO RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-8940
Mailing Address - Country:US
Mailing Address - Phone:520-616-0790
Mailing Address - Fax:
Practice Address - Street 1:13808 N SANDARIO RD STE 100
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85653-8940
Practice Address - Country:US
Practice Address - Phone:520-616-0790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental