MEDICARE: AN AMAZING SMILE, 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	122300000X	Dentist

General Provider Information

NPI Number	:	1295033769
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AN AMAZING SMILE, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 2924
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85252-2924
Country	:	US
Telephone Number	:	480-208-7436
Fax Number	:	866-316-7796

Provider Business Practice Location Address
First Line	:	8675 S PRIEST DR
Second Line	:	SUITE-101
City	:	TEMPE
State	:	AZ
Zip	:	85284-1914
Country	:	US
Telephone Number	:	480-208-7436
Fax Number	:	866-316-7796

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MAHDI A ALI
Credential	:	DMD, MPH
Telephone Number	:	480-208-7436

Provider Enumeration Date	:	03/08/2011
Last Update Date	:	03/08/2011

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