Provider Demographics
NPI:1427855485
Name:GILA RIDGE DENTISTRY WEST LLC
Entity type:Organization
Organization Name:GILA RIDGE DENTISTRY WEST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR CREDENTIALING TEAM LEAD
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA-ROCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-869-3789
Mailing Address - Street 1:2241 S AVENUE A STE 7
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8374
Mailing Address - Country:US
Mailing Address - Phone:928-783-0636
Mailing Address - Fax:928-783-0054
Practice Address - Street 1:2241 S AVENUE A STE 7
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8374
Practice Address - Country:US
Practice Address - Phone:928-783-0636
Practice Address - Fax:928-783-0054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental