MEDICARE: DR. BRIAN J DORFMAN D.M.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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	6337	AZ
2	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	32232	AZ

General Provider Information

NPI Number	:	1609871094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN J DORFMAN D.M.D., M.D.

Provider Business Mailing Address
First Line	:	42104 N VENTURE DR
Second Line	:	STE A106
City	:	ANTHEM
State	:	AZ
Zip	:	85086-3824
Country	:	US
Telephone Number	:	623-551-6556
Fax Number	:	623-551-6557

Provider Business Practice Location Address
First Line	:	42104 N VENTURE DR
Second Line	:	STE A106
City	:	ANTHEM
State	:	AZ
Zip	:	85086-3824
Country	:	US
Telephone Number	:	623-551-6556
Fax Number	:	623-551-6557

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	04/19/2012

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