MEDICARE: NOGALES DENTISTRY LLC

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	:	1336074715
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOGALES DENTISTRY LLC

Provider Business Mailing Address
First Line	:	855 W BELL RD STE 600
Second Line	:
City	:	NOGALES
State	:	AZ
Zip	:	85621-4579
Country	:	US
Telephone Number	:	520-761-1600
Fax Number	:	520-761-1708

Provider Business Practice Location Address
First Line	:	855 W BELL RD STE 600
Second Line	:
City	:	NOGALES
State	:	AZ
Zip	:	85621-4579
Country	:	US
Telephone Number	:	520-761-1600
Fax Number	:	520-761-1708

Authorized Official
Title or Position	:	OWNER
Name	:	RICHARD JOHNSON
Credential	:	DDS
Telephone Number	:	520-761-1600

Provider Enumeration Date	:	06/16/2026
Last Update Date	:	06/16/2026

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Directions to “NOGALES DENTISTRY LLC ” Practice Location

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