Provider Demographics
NPI:1619319001
Name:HALF DENTAL TUCSON, INC.
Entity Type:Organization
Organization Name:HALF DENTAL TUCSON, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:H
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:702-876-2525
Mailing Address - Street 1:2605 S DECATUR BLVD STE 116
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-8592
Mailing Address - Country:US
Mailing Address - Phone:702-876-2525
Mailing Address - Fax:702-876-1686
Practice Address - Street 1:5577 N ORACLE RD STE 101
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-3878
Practice Address - Country:US
Practice Address - Phone:520-777-0616
Practice Address - Fax:520-888-3037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental