MEDICARE: KENTON COVINGTON DDS

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	122300000X	Dentist	D3752	AZ

General Provider Information

NPI Number	:	1063581510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENTON COVINGTON DDS

Provider Business Mailing Address
First Line	:	1830 S ALMA SCHOOL RD STE 110
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85210-3086
Country	:	US
Telephone Number	:	480-834-1317
Fax Number	:	480-649-6148

Provider Business Practice Location Address
First Line	:	1830 S ALMA SCHOOL RD STE 110
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85210-3086
Country	:	US
Telephone Number	:	480-834-1317
Fax Number	:	480-649-6148

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	07/08/2007

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Directions to “ KENTON COVINGTON DDS” Practice Location

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