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NPI Code Detail

MEDICARE: ESPECIALIDADES DENTALES LTD.

MEDICARE: ESPECIALIDADES DENTALES LTD.
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
11223G0001XGeneral Practice Dentistry2628AZ

General Provider Information

NPI Number : 1356555320
Entity Type Code : Organization
Provider Name (Legal Business Name) : ESPECIALIDADES DENTALES LTD.
Provider Business Mailing Address
First Line : 4008 N 33RD AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85017-4510
Country : US
Telephone Number : 602-266-9659
Fax Number : 602-266-8275
Provider Business Practice Location Address
First Line : 4008 N 33RD AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85017-4510
Country : US
Telephone Number : 602-266-9659
Fax Number : 602-266-8275
Authorized Official
Title or Position : OWNER DENTIST
Name : DR. UTTAM B. PRAJAPATI
Credential : D.D.S.
Telephone Number : 602-266-9659
Provider Enumeration Date : 05/09/2007
Last Update Date : 08/22/2020

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Directions to “ESPECIALIDADES DENTALES LTD. ” Practice Location

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