MEDICARE: SONORAN CENTER FOR PEDIATRIC DENTISTRY, P.C.

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	3032	AZ

General Provider Information

NPI Number	:	1164619359
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SONORAN CENTER FOR PEDIATRIC DENTISTRY, P.C.

Provider Business Mailing Address
First Line	:	2402 E CERRADA DE PROMESA
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85718-3031
Country	:	US
Telephone Number	:	520-465-2421
Fax Number	:

Provider Business Practice Location Address
First Line	:	8567 N SILVERBELL RD
Second Line	:	SUITE 101
City	:	TUCSON
State	:	AZ
Zip	:	85743-9513
Country	:	US
Telephone Number	:	520-744-2663
Fax Number	:

Authorized Official
Title or Position	:	PRES
Name	:	DR. MARC ANDREW AUERBACH
Credential	:	D.D.S.
Telephone Number	:	520-744-2663

Provider Enumeration Date	:	10/02/2007
Last Update Date	:	04/06/2011

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