MEDICARE: ARIZONA DENTAL PROFESSIONALS, PC

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	6416	AZ

General Provider Information

NPI Number	:	1528259009
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARIZONA DENTAL PROFESSIONALS, PC

Provider Business Mailing Address
First Line	:	16605 E PALISADES BLVD
Second Line	:	SUITE 112
City	:	FOUNTAIN HILLS
State	:	AZ
Zip	:	85268-3716
Country	:	US
Telephone Number	:	480-837-2000
Fax Number	:	480-837-2078

Provider Business Practice Location Address
First Line	:	16605 E PALISADES BLVD
Second Line	:	SUITE 112
City	:	FOUNTAIN HILLS
State	:	AZ
Zip	:	85268-3716
Country	:	US
Telephone Number	:	480-837-2000
Fax Number	:	480-837-2078

Authorized Official
Title or Position	:	CREDENTIALING SUPERVISOR
Name	:	KENDRA WALKER
Credential	:
Telephone Number	:	217-540-8312

Provider Enumeration Date	:	08/08/2007
Last Update Date	:	11/18/2016

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