Provider Demographics
NPI:1821305798
Name:RANCHO SANTA FE DENTAL GROUP
Entity Type:Organization
Organization Name:RANCHO SANTA FE DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MY-ANH
Authorized Official - Middle Name:T
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:623-536-3377
Mailing Address - Street 1:13048 W RANCHO SANTA FE BLVD
Mailing Address - Street 2:114
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-1705
Mailing Address - Country:US
Mailing Address - Phone:623-536-3377
Mailing Address - Fax:
Practice Address - Street 1:13048 W RANCHO SANTA FE BLVD
Practice Address - Street 2:114
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-1705
Practice Address - Country:US
Practice Address - Phone:623-536-3377
Practice Address - Fax:623-536-3088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-13
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD69701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty