MEDICARE: ROBERT DICUS, DDS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	1613	AZ

General Provider Information

NPI Number	:	1023145398
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT DICUS, DDS, PC

Provider Business Mailing Address
First Line	:	7500 E MCDONALD DR STE 101B
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85250-6000
Country	:	US
Telephone Number	:	480-998-2233
Fax Number	:

Provider Business Practice Location Address
First Line	:	7500 E MCDONALD DR STE 101B
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85250-6000
Country	:	US
Telephone Number	:	480-998-2233
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	BRENDA CALHOUN
Credential	:
Telephone Number	:	480-998-2233

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	08/22/2020

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