MEDICARE: DENTAL EQUITY PARTNERS

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	D7678	AZ

General Provider Information

NPI Number	:	1407231459
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL EQUITY PARTNERS

Provider Business Mailing Address
First Line	:	11390 E VIA LINDA
Second Line	:	SUITE 104
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85259-4075
Country	:	US
Telephone Number	:	480-282-3437
Fax Number	:

Provider Business Practice Location Address
First Line	:	11390 E VIA LINDA
Second Line	:	SUITE 104
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85259-4075
Country	:	US
Telephone Number	:	480-282-3437
Fax Number	:

Authorized Official
Title or Position	:	ADVISOR
Name	:	DR. HOWARD CHOI
Credential	:	DDS, MS
Telephone Number	:	480-282-3437

Provider Enumeration Date	:	07/20/2015
Last Update Date	:	07/20/2015

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