Provider Demographics
NPI:1720748049
Name:RADIANT DENTAL LLC
Entity Type:Organization
Organization Name:RADIANT DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:LIANA
Authorized Official - Last Name:ARMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-577-7367
Mailing Address - Street 1:19251 E OASIS DR
Mailing Address - Street 2:
Mailing Address - City:BLACK CANYON CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85324-8878
Mailing Address - Country:US
Mailing Address - Phone:623-526-2607
Mailing Address - Fax:
Practice Address - Street 1:19251 E OASIS DR
Practice Address - Street 2:
Practice Address - City:BLACK CANYON CITY
Practice Address - State:AZ
Practice Address - Zip Code:85324-8878
Practice Address - Country:US
Practice Address - Phone:623-526-2607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-28
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty