MEDICARE: ARIZONA DENTAL PROFESSIONALS, P.C.

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

General Provider Information

NPI Number	:	1952628984
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARIZONA DENTAL PROFESSIONALS, P.C.

Provider Business Mailing Address
First Line	:	371 LAKE HAVASU AVE S
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-9307
Country	:	US
Telephone Number	:	928-855-8333
Fax Number	:

Provider Business Practice Location Address
First Line	:	371 LAKE HAVASU AVE S
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-9307
Country	:	US
Telephone Number	:	928-855-8333
Fax Number	:

Authorized Official
Title or Position	:	INSURANCE COORDINATOR
Name	:	CARMEN WOODS
Credential	:
Telephone Number	:	217-540-5100

Provider Enumeration Date	:	04/30/2010
Last Update Date	:	02/04/2014

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