=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083848006
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PERSONAL TOUCH DENTISTRY, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2009
-----------------------------------------------------
Last Update Date | 05/05/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13065 W MCDOWELL RD SUITE B 112
-----------------------------------------------------
City | AVONDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85392-6439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-547-2273
-----------------------------------------------------
Fax | 623-547-3878
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13065 W MCDOWELL RD SUITE B 112
-----------------------------------------------------
City | AVONDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85392-6439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-547-2273
-----------------------------------------------------
Fax | 623-547-3878
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MS. SHAWN ENGLISH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 623-547-2273
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 5171
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------