MEDICARE: KRISTEN M MAYORGA 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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1750020186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KRISTEN M MAYORGA PLLC

Provider Business Mailing Address
First Line	:	3502 E DESERT TRUMPET RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-7028
Country	:	US
Telephone Number	:	480-639-9165
Fax Number	:

Provider Business Practice Location Address
First Line	:	4609 E CHANDLER BLVD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85048-0424
Country	:	US
Telephone Number	:	480-706-4600
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR/OWNER
Name	:	DR. KRISTEN M MAYORGA
Credential	:	DDS
Telephone Number	:	480-639-9165

Provider Enumeration Date	:	06/02/2022
Last Update Date	:	06/02/2022

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