MEDICARE: KRIS ANDREW VOLCHECK DDS

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	3480	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	794736	OTHER	AZ	AHCCCS

General Provider Information

NPI Number	:	1104937606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRIS ANDREW VOLCHECK DDS

Provider Business Mailing Address
First Line	:	230 S 12TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85007-3101
Country	:	US
Telephone Number	:	602-256-6945
Fax Number	:	602-417-9803

Provider Business Practice Location Address
First Line	:	230 S 12TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85007-3101
Country	:	US
Telephone Number	:	602-256-6945
Fax Number	:	602-417-9803

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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