MEDICARE: DR. SALLY HANCILES D.M.D.

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	D009266	AZ

General Provider Information

NPI Number	:	1063895225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SALLY HANCILES D.M.D.

Provider Business Mailing Address
First Line	:	4500 S DOBSON RD
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85248-4907
Country	:	US
Telephone Number	:	480-554-8080
Fax Number	:

Provider Business Practice Location Address
First Line	:	4500 S DOBSON RD
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85248-4907
Country	:	US
Telephone Number	:	480-554-8080
Fax Number	:

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

Provider Enumeration Date	:	07/07/2015
Last Update Date	:	06/18/2018

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