Provider Demographics
NPI:1669636189
Name:THG DENTAL, PLLC
Entity Type:Organization
Organization Name:THG DENTAL, PLLC
Other - Org Name:TANGERINE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRYM
Authorized Official - Middle Name:H
Authorized Official - Last Name:GIBBONS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-616-4610
Mailing Address - Street 1:12090 N. THORNYDALE, STE 106
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85658-4779
Mailing Address - Country:US
Mailing Address - Phone:520-616-4610
Mailing Address - Fax:520-616-4609
Practice Address - Street 1:12090 N. THORNYDALE, STE 106
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85658-4779
Practice Address - Country:US
Practice Address - Phone:520-616-4610
Practice Address - Fax:520-616-4609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ65661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty