MEDICARE: WESTSIDE DENTAL 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	D5786	AZ

General Provider Information

NPI Number	:	1356374714
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTSIDE DENTAL P.C.

Provider Business Mailing Address
First Line	:	2330 N 75TH AVE STE 112
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85035-1200
Country	:	US
Telephone Number	:	623-849-0477
Fax Number	:

Provider Business Practice Location Address
First Line	:	2330 N 75TH AVE STE 112
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85035-1200
Country	:	US
Telephone Number	:	623-849-0477
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GEORGE SPINE
Credential	:	D.M.D.
Telephone Number	:	623-849-0477

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	08/22/2020

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Directions to “WESTSIDE DENTAL P.C. ” Practice Location

Language	Start Address	Practice Location

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