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NPI Code Detail

MEDICARE: MY KIDZ DENTISTRY

MEDICARE: MY KIDZ DENTISTRY
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
11223P0221XPediatric Dentistry2428AZ

General Provider Information

NPI Number : 1407882681
Entity Type Code : Organization
Provider Name (Legal Business Name) : MY KIDZ DENTISTRY
Provider Business Mailing Address
First Line : 1728 W GLENDALE AVE
Second Line : #305
City : PHOENIX
State : AZ
Zip : 85021-8860
Country : US
Telephone Number : 602-995-7336
Fax Number : 602-995-2665
Provider Business Practice Location Address
First Line : 1728 W GLENDALE AVE
Second Line : #305
City : PHOENIX
State : AZ
Zip : 85021-8860
Country : US
Telephone Number : 602-995-7336
Fax Number : 602-995-2665
Authorized Official
Title or Position : CENTRAL OFFICE MANAGER
Name : MRS. JANICE LYNN PRATT
Credential :
Telephone Number : 602-995-7336
Provider Enumeration Date : 06/23/2006
Last Update Date : 08/22/2020

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Directions to “MY KIDZ DENTISTRY ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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