MEDICARE: AFFORDABLE DENTURES - PHOENIX - BETHANY HOME II, P.C.

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	122300000X	Dentist

General Provider Information

NPI Number	:	1144888652
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFORDABLE DENTURES - PHOENIX - BETHANY HOME II, P.C.

Provider Business Mailing Address
First Line	:	2316 W BETHANY HOME RD STE 101
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-1850
Country	:	US
Telephone Number	:	602-841-7548
Fax Number	:

Provider Business Practice Location Address
First Line	:	2316 W BETHANY HOME RD STE 101
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-1850
Country	:	US
Telephone Number	:	602-841-7548
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHERYLL HOWARD
Credential	:	DDS
Telephone Number	:	602-841-7548

Provider Enumeration Date	:	05/30/2019
Last Update Date	:	05/30/2019

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