MEDICARE: TEMPE 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	D008289	AZ

General Provider Information

NPI Number	:	1336542786
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEMPE FAMILY DENTAL PLLC

Provider Business Mailing Address
First Line	:	6200 S MCCLINTOCK DR STE 115
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85283-3449
Country	:	US
Telephone Number	:	480-838-3103
Fax Number	:	480-838-3458

Provider Business Practice Location Address
First Line	:	6200 S MCCLINTOCK DR STE 115
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85283-3449
Country	:	US
Telephone Number	:	480-838-3103
Fax Number	:	480-838-3458

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHASE DAVIS
Credential	:	DDS
Telephone Number	:	480-838-3103

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

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