Provider Demographics
NPI:1649391293
Name:RED ROCK FAMILY DENTISTRY, LTD.
Entity Type:Organization
Organization Name:RED ROCK FAMILY DENTISTRY, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:CULLIMORE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-782-8111
Mailing Address - Street 1:908 W CHANDLER BLVD
Mailing Address - Street 2:STE. C-7
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-2548
Mailing Address - Country:US
Mailing Address - Phone:480-782-8111
Mailing Address - Fax:480-857-2609
Practice Address - Street 1:908 W CHANDLER BLVD
Practice Address - Street 2:STE. C-7
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-2548
Practice Address - Country:US
Practice Address - Phone:480-782-8111
Practice Address - Fax:480-857-2609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ46681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty