MEDICARE: MOLAR MAGIC, LLC

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	6854	AZ

General Provider Information

NPI Number	:	1164708350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOLAR MAGIC, LLC

Provider Business Mailing Address
First Line	:	1864 E FLORENCE BLVD
Second Line	:	SUITE 1
City	:	CASA GRANDE
State	:	AZ
Zip	:	85122-5457
Country	:	US
Telephone Number	:	520-876-5200
Fax Number	:	480-393-0926

Provider Business Practice Location Address
First Line	:	1864 E FLORENCE BLVD
Second Line	:	SUITE 1
City	:	CASA GRANDE
State	:	AZ
Zip	:	85122-5457
Country	:	US
Telephone Number	:	520-876-5200
Fax Number	:	480-393-0926

Authorized Official
Title or Position	:	OWNER
Name	:	DR. THIEN CHI PHAM
Credential	:	DDS
Telephone Number	:	520-876-5200

Provider Enumeration Date	:	11/01/2011
Last Update Date	:	11/01/2011

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Directions to “MOLAR MAGIC, LLC ” Practice Location

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