Provider Demographics
NPI:1811325525
Name:GUMANGAN, RHODELIA JANE (DDS)
Entity type:Individual
Prefix:DR
First Name:RHODELIA JANE
Middle Name:
Last Name:GUMANGAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8151 E INDIAN BEND RD
Mailing Address - Street 2:STE 111
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-4826
Mailing Address - Country:US
Mailing Address - Phone:480-607-9999
Mailing Address - Fax:
Practice Address - Street 1:295 W VALENCIA RD
Practice Address - Street 2:SUITE 1287
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85706-7046
Practice Address - Country:US
Practice Address - Phone:602-996-6065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD008847122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist