Provider Demographics
NPI:1235022278
Name:MOUNTAIN RANCH FAMILY & COSMETIC DENTISTRY
Entity type:Organization
Organization Name:MOUNTAIN RANCH FAMILY & COSMETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPAULDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-327-0231
Mailing Address - Street 1:17650 W ELLIOT RD STE A120
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-9013
Mailing Address - Country:US
Mailing Address - Phone:623-327-0231
Mailing Address - Fax:
Practice Address - Street 1:17650 W ELLIOT RD STE A120
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-9013
Practice Address - Country:US
Practice Address - Phone:623-327-0231
Practice Address - Fax:623-327-9158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental