MEDICARE: TEAM KIDS DENTAL PLLC

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	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1144168626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEAM KIDS DENTAL PLLC

Provider Business Mailing Address
First Line	:	4350 E RAY RD STE 121
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-4705
Country	:	US
Telephone Number	:	480-759-3333
Fax Number	:	480-621-7022

Provider Business Practice Location Address
First Line	:	4350 E RAY RD STE 121
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-4705
Country	:	US
Telephone Number	:	480-759-3333
Fax Number	:	480-621-7022

Authorized Official
Title or Position	:	FINANCE DIRECTOR
Name	:	MANDY DAVIS
Credential	:
Telephone Number	:	480-759-3333

Provider Enumeration Date	:	03/24/2026
Last Update Date	:	03/24/2026

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