MEDICARE: ANDREW PHILIP SERRANO DMD

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	9697	AZ

General Provider Information

NPI Number	:	1336656024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW PHILIP SERRANO DMD

Provider Business Mailing Address
First Line	:	1515 E MISSOURI AVE STE 101
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-2443
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 E MISSOURI AVE STE 101
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-2443
Country	:	US
Telephone Number	:	602-274-7840
Fax Number	:

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

Provider Enumeration Date	:	01/04/2018
Last Update Date	:	01/04/2018

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