Provider Demographics
NPI:1952522443
Name:OAK VALLEY FAMILY DENTISTRY
Entity Type:Organization
Organization Name:OAK VALLEY FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HAI
Authorized Official - Middle Name:Q
Authorized Official - Last Name:TRANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-888-8053
Mailing Address - Street 1:22717 S ELLSWORTH RD # B-102
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85242-6119
Mailing Address - Country:US
Mailing Address - Phone:480-888-8053
Mailing Address - Fax:
Practice Address - Street 1:22717 S ELLSWORTH RD # B-102
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85242-6119
Practice Address - Country:US
Practice Address - Phone:480-888-8053
Practice Address - Fax:480-882-1042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ61771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty