MEDICARE: MARBELLA DENTAL STUDIO

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1053110494
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARBELLA DENTAL STUDIO

Provider Business Mailing Address
First Line	:	4845 E THUNDERBIRD RD STE 3
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85254-3539
Country	:	US
Telephone Number	:	602-996-1660
Fax Number	:	602-996-2321

Provider Business Practice Location Address
First Line	:	4845 E THUNDERBIRD RD STE 3
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85254-3539
Country	:	US
Telephone Number	:	602-996-1660
Fax Number	:	602-996-2321

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. PAOLA A FANN
Credential	:
Telephone Number	:	480-202-3250

Provider Enumeration Date	:	03/10/2025
Last Update Date	:	03/12/2025

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1700602307 — MARBELLA DENTAL CONSULTANTS LLC
Practice Location Address:

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Practice Fax: 602-996-2321

Directions to “MARBELLA DENTAL STUDIO ” Practice Location

Language	Start Address	Practice Location

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