Provider Demographics
NPI:1669953774
Name:MEDRANO, ARLEY (DDS, MS)
Entity type:Individual
Prefix:
First Name:ARLEY
Middle Name:
Last Name:MEDRANO
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2422 GLENGARIFF DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-2934
Mailing Address - Country:US
Mailing Address - Phone:509-322-5320
Mailing Address - Fax:
Practice Address - Street 1:711 S CLAY ST STE A
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-5748
Practice Address - Country:US
Practice Address - Phone:972-875-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60884780122300000X, 1223P0221X
TX392591223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist