MEDICARE: CONTINENTAL DENTAL CARE MILL AVENUE LLC

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	:	1316167216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONTINENTAL DENTAL CARE MILL AVENUE LLC

Provider Business Mailing Address
First Line	:	122 SKYVIEW DRIVE
Second Line	:
City	:	BELLEFONTE
State	:	PA
Zip	:	16823
Country	:	US
Telephone Number	:	814-355-2945
Fax Number	:

Provider Business Practice Location Address
First Line	:	2210 S MILL AVE STE 2
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-2153
Country	:	US
Telephone Number	:	480-921-2434
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARK EICH
Credential	:
Telephone Number	:	480-921-2434

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	08/22/2020

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