Organization
CRISMON ROAD DMSO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY H TRAN MBA/MPH (MANAGER)
(408) 234-5099
Entity
Organization
Contact information
Practice address
1157 S CRISMON RD STE 103, MESA, AZ 85208-2661
(480) 393-0687
Mailing address
1157 S CRISMON RD STE 103, MESA, AZ 85208-2661
(480) 393-0687
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
AZ
Other
Enumeration date
08/03/2017
Last updated
07/21/2022
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