MEDICARE: 7 TO 7 FAMILY DENTAL PLLC

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

General Provider Information

NPI Number	:	1245621895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	7 TO 7 FAMILY DENTAL PLLC

Provider Business Mailing Address
First Line	:	4502 W INDIAN SCHOOL RD
Second Line	:	SUITE A2
City	:	PHOENIX
State	:	AZ
Zip	:	85031-2800
Country	:	US
Telephone Number	:	623-873-2538
Fax Number	:

Provider Business Practice Location Address
First Line	:	4502 W INDIAN SCHOOL RD
Second Line	:	SUITE A2
City	:	PHOENIX
State	:	AZ
Zip	:	85031-2800
Country	:	US
Telephone Number	:	623-873-2538
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. ANNETTE RENEE RICHARDSON
Credential	:
Telephone Number	:	623-873-2538

Provider Enumeration Date	:	02/17/2015
Last Update Date	:	02/17/2015

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