MEDICARE: WEST VALLEY PEDIATRIC DENTISTRY

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	1223P0221X	Pediatric Dentistry	D5164	AZ

General Provider Information

NPI Number	:	1083767768
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST VALLEY PEDIATRIC DENTISTRY

Provider Business Mailing Address
First Line	:	13575 W INDIAN SCHOOL RD STE 1000
Second Line	:
City	:	LITCHFIELD PARK
State	:	AZ
Zip	:	85340-4926
Country	:	US
Telephone Number	:	623-935-9873
Fax Number	:	623-935-3626

Provider Business Practice Location Address
First Line	:	13575 W INDIAN SCHOOL RD STE 1000
Second Line	:
City	:	LITCHFIELD PARK
State	:	AZ
Zip	:	85340-4926
Country	:	US
Telephone Number	:	623-935-9873
Fax Number	:	623-935-3626

Authorized Official
Title or Position	:	DENTIST OWNER
Name	:	DR. JEFFREY NEIL BROWNSTEIN
Credential	:	D.D.S.
Telephone Number	:	623-935-9873

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	09/06/2007

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