MEDICARE: MOON PAYNE MANAGEMENT LLP

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	D5136	AZ
2	1223G0001X	General Practice Dentistry	D5144	AZ

General Provider Information

NPI Number	:	1063635985
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOON PAYNE MANAGEMENT LLP

Provider Business Mailing Address
First Line	:	3930 S ALMA SCHOOL RD
Second Line	:	BLDG. B, STE. 6
City	:	CHANDLER
State	:	AZ
Zip	:	85248-4510
Country	:	US
Telephone Number	:	480-222-8083
Fax Number	:	480-222-8084

Provider Business Practice Location Address
First Line	:	3930 S ALMA SCHOOL RD
Second Line	:	BLDG. B, STE. 6
City	:	CHANDLER
State	:	AZ
Zip	:	85248-4510
Country	:	US
Telephone Number	:	480-222-8083
Fax Number	:	480-222-8084

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MRS. DEBBIE A GRAGG
Credential	:
Telephone Number	:	480-222-8083

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	08/22/2020

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