MEDICARE: EPIC FAMILY DENTAL CARE INC

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

General Provider Information

NPI Number	:	1174985832
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EPIC FAMILY DENTAL CARE INC

Provider Business Mailing Address
First Line	:	10855 N TATUM BLVD
Second Line	:	SUITE 170
City	:	PHOENIX
State	:	AZ
Zip	:	85028-3052
Country	:	US
Telephone Number	:	480-948-2273
Fax Number	:	480-948-3449

Provider Business Practice Location Address
First Line	:	10855 N TATUM BLVD
Second Line	:	SUITE 170
City	:	PHOENIX
State	:	AZ
Zip	:	85028-3052
Country	:	US
Telephone Number	:	480-948-2273
Fax Number	:	480-948-3449

Authorized Official
Title or Position	:	REGIONAL MANAGER
Name	:	CLAUDIA RUIZ
Credential	:
Telephone Number	:	480-948-2273

Provider Enumeration Date	:	03/22/2016
Last Update Date	:	03/22/2016

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