MEDICARE: DESERT DENTISTRY, 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	122300000X	Dentist

General Provider Information

NPI Number	:	1194843987
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESERT DENTISTRY, PLLC

Provider Business Mailing Address
First Line	:	4609 E CHANDLER BLVD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85048-0424
Country	:	US
Telephone Number	:	480-706-4600
Fax Number	:

Provider Business Practice Location Address
First Line	:	4609 E CHANDLER BLVD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85048-0424
Country	:	US
Telephone Number	:	480-706-4600
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. THOMAS M MATTERN
Credential	:	DDS
Telephone Number	:	480-706-4600

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	05/21/2015

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