Provider Demographics
NPI:1659820819
Name:VALUE DENTAL CENTERS MESA EAST AZ, LLC
Entity Type:Organization
Organization Name:VALUE DENTAL CENTERS MESA EAST AZ, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:H
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA/MPH
Authorized Official - Phone:408-234-5099
Mailing Address - Street 1:4505 E MCKELLIPS RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-2523
Mailing Address - Country:US
Mailing Address - Phone:480-626-8060
Mailing Address - Fax:702-800-3103
Practice Address - Street 1:4505 E MCKELLIPS RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-2523
Practice Address - Country:US
Practice Address - Phone:480-626-8060
Practice Address - Fax:702-800-3103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental