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NPI Code Detail

MEDICARE: PREVENTATIVE DENTAL CARE PLLC

MEDICARE: PREVENTATIVE DENTAL CARE PLLC
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
1261QD0000XDental Clinic/Center

General Provider Information

NPI Number : 1033690169
Entity Type Code : Organization
Provider Name (Legal Business Name) : PREVENTATIVE DENTAL CARE PLLC
Provider Business Mailing Address
First Line : 19251 E OASIS DR
Second Line :
City : BLACK CANYON CITY
State : AZ
Zip : 85324-8878
Country : US
Telephone Number : 162-344-4232
Fax Number :
Provider Business Practice Location Address
First Line : 19251 E OASIS DR
Second Line :
City : BLACK CANYON CITY
State : AZ
Zip : 85324-8878
Country : US
Telephone Number : 162-344-4232
Fax Number :
Authorized Official
Title or Position : OWNER
Name : SCOTT W HIRSBRUNNER
Credential : DMD
Telephone Number : 623-444-2322
Provider Enumeration Date : 08/27/2018
Last Update Date : 08/27/2018

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Directions to “PREVENTATIVE DENTAL CARE PLLC ” Practice Location

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