MEDICARE: ADVANCED DENTAL CONCEPTS 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	2398AZ	AZ

General Provider Information

NPI Number	:	1194890152
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED DENTAL CONCEPTS PC

Provider Business Mailing Address
First Line	:	801 S POWER ROAD
Second Line	:	SUITE 104
City	:	MESA
State	:	AZ
Zip	:	85206-5222
Country	:	US
Telephone Number	:	480-807-9559
Fax Number	:	480-807-6876

Provider Business Practice Location Address
First Line	:	801 S POWER ROAD
Second Line	:	SUITE 104
City	:	MESA
State	:	AZ
Zip	:	85206-5222
Country	:	US
Telephone Number	:	480-807-9559
Fax Number	:	480-807-6876

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PATRICK M SMITH
Credential	:	DDS
Telephone Number	:	480-807-9559

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	08/22/2020

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