Provider Demographics
NPI:1386280840
Name:TRU DENTAL LLC
Entity type:Organization
Organization Name:TRU DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-210-3416
Mailing Address - Street 1:26943 N 97TH LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-2931
Mailing Address - Country:US
Mailing Address - Phone:623-210-3416
Mailing Address - Fax:
Practice Address - Street 1:8325 W. HAPPY VALLEY RD
Practice Address - Street 2:BUILDING 1 SUITE 100
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-8538
Practice Address - Country:US
Practice Address - Phone:623-210-3416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZNAOtherNA