Provider Demographics
NPI:1841523420
Name:RADIANT COMPLEXIONS OF CHANDLER PLC
Entity type:Organization
Organization Name:RADIANT COMPLEXIONS OF CHANDLER PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-226-8484
Mailing Address - Street 1:270 W CHANDLER HEIGHTS RD
Mailing Address - Street 2:BLDG 200B SUITE 4
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-5055
Mailing Address - Country:US
Mailing Address - Phone:480-726-7646
Mailing Address - Fax:480-726-7546
Practice Address - Street 1:270 W CHANDLER HEIGHTS RD
Practice Address - Street 2:BLDG 200B SUITE 4
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-5055
Practice Address - Country:US
Practice Address - Phone:480-726-7646
Practice Address - Fax:480-726-7546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty