MEDICARE: MRS. MARTA C. PERSINGER D.D.S.

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	D5145	AZ

General Provider Information

NPI Number	:	1255362117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARTA C. PERSINGER D.D.S.

Provider Business Mailing Address
First Line	:	12596 N 72ND PL
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85260-4758
Country	:	US
Telephone Number	:	602-867-4567
Fax Number	:	602-867-0829

Provider Business Practice Location Address
First Line	:	4022 E GREENWAY RD
Second Line	:	#13
City	:	PHOENIX
State	:	AZ
Zip	:	85032-4797
Country	:	US
Telephone Number	:	602-867-4567
Fax Number	:	602-867-0829

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	07/08/2007

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