MEDICARE: KAY 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	332BC3200X	Customized Equipment (DME)	D052454	AZ

General Provider Information

NPI Number	:	1881016129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAY DENTAL PLLC

Provider Business Mailing Address
First Line	:	9180 N COACHLINE BLVD
Second Line	:	SUITE 102
City	:	TUCSON
State	:	AZ
Zip	:	85743-7360
Country	:	US
Telephone Number	:	520-577-0035
Fax Number	:	520-577-0044

Provider Business Practice Location Address
First Line	:	9180 N COACHLINE BLVD
Second Line	:	SUITE 102
City	:	TUCSON
State	:	AZ
Zip	:	85743-7360
Country	:	US
Telephone Number	:	520-577-0035
Fax Number	:	520-577-0044

Authorized Official
Title or Position	:	DOCTOR/OWNER
Name	:	DR. SOPHAN REATH KAY
Credential	:	D.D.S.
Telephone Number	:	520-577-0035

Provider Enumeration Date	:	01/06/2014
Last Update Date	:	01/13/2014

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Directions to “KAY DENTAL PLLC ” Practice Location

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