Healthcare Provider Details

I. General information

NPI: 1447442546
Provider Name (Legal Business Name): AURELIA BEDARD D.D.S., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18555 N 79TH AVE STE A102
GLENDALE AZ
85308-8371
US

IV. Provider business mailing address

3404 E TOPEKA DR
PHOENIX AZ
85050-6324
US

V. Phone/Fax

Practice location:
  • Phone: 623-487-5800
  • Fax:
Mailing address:
  • Phone: 623-487-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD6728
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: