Provider Demographics
NPI:1588932651
Name:TUCSON SMILES PEDIATRIC DENTISTRY AT RITA RANCH
Entity type:Organization
Organization Name:TUCSON SMILES PEDIATRIC DENTISTRY AT RITA RANCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BETANCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-664-9000
Mailing Address - Street 1:8265 S HOUGHTON RD
Mailing Address - Street 2:SUITE 131
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747-5765
Mailing Address - Country:US
Mailing Address - Phone:520-664-9000
Mailing Address - Fax:520-664-2090
Practice Address - Street 1:8265 S HOUGHTON RD
Practice Address - Street 2:SUITE 131
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747-5765
Practice Address - Country:US
Practice Address - Phone:520-664-9000
Practice Address - Fax:520-664-2090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ56791223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty