MEDICARE: CORTARO DENTAL CARE PC

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	D4718	AZ

General Provider Information

NPI Number	:	1144355470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORTARO DENTAL CARE PC

Provider Business Mailing Address
First Line	:	3603 W CORTARO FARMS ROAD
Second Line	:	SUITE #113
City	:	TUCSON
State	:	AZ
Zip	:	85742-8615
Country	:	US
Telephone Number	:	520-572-1593
Fax Number	:	520-572-0793

Provider Business Practice Location Address
First Line	:	3603 W CORTARO FARMS ROAD
Second Line	:	SUITE #113
City	:	TUCSON
State	:	AZ
Zip	:	85742-8615
Country	:	US
Telephone Number	:	520-572-1593
Fax Number	:	520-572-0793

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. MARGIE D DERRICK
Credential	:
Telephone Number	:	520-572-1593

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	08/24/2010

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