MEDICARE: JASON ACUFF D.D.S.

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	122300000X	Dentist	4814	AZ

General Provider Information

NPI Number	:	1992195101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON ACUFF D.D.S.

Provider Business Mailing Address
First Line	:	11335 W BUCKEYE RD STE C101
Second Line	:
City	:	AVONDALE
State	:	AZ
Zip	:	85323-6814
Country	:	US
Telephone Number	:	623-478-0149
Fax Number	:

Provider Business Practice Location Address
First Line	:	11335 W BUCKEYE RD STE C101
Second Line	:
City	:	AVONDALE
State	:	AZ
Zip	:	85323-6814
Country	:	US
Telephone Number	:	623-478-0149
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2015
Last Update Date	:	01/26/2015

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