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NPI Code Detail

MEDICARE: FLORENCE DENTAL MANAGEMENT CO, PC

MEDICARE: FLORENCE DENTAL MANAGEMENT CO, 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
1122300000XDentistAZ
21223G0001XGeneral Practice DentistryAZ

General Provider Information

NPI Number : 1235422122
Entity Type Code : Organization
Provider Name (Legal Business Name) : FLORENCE DENTAL MANAGEMENT CO, PC
Provider Business Mailing Address
First Line : 4704 E SOUTHERN AVE
Second Line :
City : MESA
State : AZ
Zip : 85206-2737
Country : US
Telephone Number : 480-889-9457
Fax Number : 480-889-9493
Provider Business Practice Location Address
First Line : 4704 E SOUTHERN AVE
Second Line :
City : MESA
State : AZ
Zip : 85206-2737
Country : US
Telephone Number : 480-889-9457
Fax Number : 480-889-9493
Authorized Official
Title or Position : PRESIDENT
Name : DR. ERIC KERBS
Credential : DDS
Telephone Number : 480-889-9457
Provider Enumeration Date : 05/25/2011
Last Update Date : 10/31/2013

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Directions to “FLORENCE DENTAL MANAGEMENT CO, PC ” Practice Location

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