MEDICARE: PALM DENTAL PLLC

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	5484	AZ

General Provider Information

NPI Number	:	1700111580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALM DENTAL PLLC

Provider Business Mailing Address
First Line	:	2030 W BASELINE RD
Second Line	:	SUITE 176
City	:	PHOENIX
State	:	AZ
Zip	:	85041-6574
Country	:	US
Telephone Number	:	602-759-5861
Fax Number	:	623-742-9580

Provider Business Practice Location Address
First Line	:	2030 W BASELINE RD
Second Line	:	SUITE 176
City	:	PHOENIX
State	:	AZ
Zip	:	85041-6574
Country	:	US
Telephone Number	:	602-759-5861
Fax Number	:	623-742-9580

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. DAVID MARCUS CHEI
Credential	:	DMD
Telephone Number	:	602-759-5861

Provider Enumeration Date	:	10/12/2009
Last Update Date	:	10/12/2009

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