Provider Demographics
NPI:1952741530
Name:HMS DENTAL PLLC
Entity Type:Organization
Organization Name:HMS DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position: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:480-888-9596
Mailing Address - Street 1:22717 S ELLSWORTH RD STE B102
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-7575
Mailing Address - Country:US
Mailing Address - Phone:480-888-9596
Mailing Address - Fax:480-882-1042
Practice Address - Street 1:22717 S ELLSWORTH RD STE B102
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-7575
Practice Address - Country:US
Practice Address - Phone:480-888-9596
Practice Address - Fax:480-882-1042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6177305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ955156OtherAHCCCS