MEDICARE: ALL FAMILY DENTAL CARE, 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	261QD0000X	Dental Clinic/Center	6633	AZ

General Provider Information

NPI Number	:	1205961166
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL FAMILY DENTAL CARE, LLC

Provider Business Mailing Address
First Line	:	PO BOX 1546
Second Line	:
City	:	COOLIDGE
State	:	AZ
Zip	:	85228-1546
Country	:	US
Telephone Number	:	520-723-1111
Fax Number	:

Provider Business Practice Location Address
First Line	:	417 W CENTRAL AVE
Second Line	:
City	:	COOLIDGE
State	:	AZ
Zip	:	85228-4708
Country	:	US
Telephone Number	:	520-723-1111
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MAX A ALMODOVAR
Credential	:	DMD
Telephone Number	:	602-391-6649

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	08/22/2020

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