MEDICARE: ARIZONA DENTAL PROFESSIONALS, P.C.

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	:	1306249792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARIZONA DENTAL PROFESSIONALS, P.C.

Provider Business Mailing Address
First Line	:	7475 W TWIN PEAKS RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85743-1518
Country	:	US
Telephone Number	:	520-579-1500
Fax Number	:

Provider Business Practice Location Address
First Line	:	7475 W TWIN PEAKS RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85743-1518
Country	:	US
Telephone Number	:	520-579-1500
Fax Number	:

Authorized Official
Title or Position	:	CRED SUPERVISOR
Name	:	KIM WILSON
Credential	:
Telephone Number	:	217-540-5170

Provider Enumeration Date	:	09/30/2014
Last Update Date	:	09/30/2014

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