MEDICARE: DR. TZVETELINA MLADENOVA D.M.D.

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	5964	AZ

General Provider Information

NPI Number	:	1396820205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TZVETELINA MLADENOVA D.M.D.

Provider Business Mailing Address
First Line	:	1043 E. MISSOURI AVE.
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014
Country	:	US
Telephone Number	:	602-216-0100
Fax Number	:	602-216-0200

Provider Business Practice Location Address
First Line	:	1043 E. MISSOURI AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014
Country	:	US
Telephone Number	:	602-216-0100
Fax Number	:	602-216-0200

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	08/31/2012

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