MEDICARE: DR. BERNARD M FLORENTO DDS

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	D06432	AZ

General Provider Information

NPI Number	:	1003977927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BERNARD M FLORENTO DDS

Provider Business Mailing Address
First Line	:	14560 W MEDLOCK DR
Second Line	:
City	:	LITCHFIELD PARK
State	:	AZ
Zip	:	85340-2811
Country	:	US
Telephone Number	:	602-828-0578
Fax Number	:

Provider Business Practice Location Address
First Line	:	2330 N 75TH AVE STE 112
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85035-1200
Country	:	US
Telephone Number	:	623-849-0477
Fax Number	:	623-849-6111

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

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	01/11/2019

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