MEDICARE: AFFORDABLE DENTURES & IMPLANTS - BULLHEAD CITY V, 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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1184338725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFORDABLE DENTURES & IMPLANTS - BULLHEAD CITY V, P.C.

Provider Business Mailing Address
First Line	:	3699 HIGHWAY 95 STE 316B
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-9123
Country	:	US
Telephone Number	:	928-704-9242
Fax Number	:

Provider Business Practice Location Address
First Line	:	3699 HIGHWAY 95 STE 316B
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-9123
Country	:	US
Telephone Number	:	928-704-9242
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SIBERA TROY BRANNON
Credential	:	DDS
Telephone Number	:	928-704-9242

Provider Enumeration Date	:	01/09/2023
Last Update Date	:	10/25/2023

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