MEDICARE: MBDT DENTAL INC

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	261QD0000X	Dental Clinic/Center	D008789	AZ

General Provider Information

NPI Number	:	1699164103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MBDT DENTAL INC

Provider Business Mailing Address
First Line	:	5577 N ORACLE RD
Second Line	:	SUITE 101
City	:	TUCSON
State	:	AZ
Zip	:	85704-3877
Country	:	US
Telephone Number	:	520-777-0616
Fax Number	:

Provider Business Practice Location Address
First Line	:	5577 N ORACLE RD
Second Line	:	SUITE 101
City	:	TUCSON
State	:	AZ
Zip	:	85704-3877
Country	:	US
Telephone Number	:	520-777-0616
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT JAMES HOUCHIN
Credential	:	DDS
Telephone Number	:	909-576-3999

Provider Enumeration Date	:	01/21/2015
Last Update Date	:	01/21/2015

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Directions to “MBDT DENTAL INC ” Practice Location

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