MEDICARE: DR. KENNETH ERNEST DANYLUK D.M.D.

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	5346	AZ

General Provider Information

NPI Number	:	1376654715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH ERNEST DANYLUK D.M.D.

Provider Business Mailing Address
First Line	:	16638 S MOUNTAIN STONE TRL
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85048-2081
Country	:	US
Telephone Number	:	480-759-3333
Fax Number	:

Provider Business Practice Location Address
First Line	:	4350 E RAY RD STE 121 BLDG 4
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-4705
Country	:	US
Telephone Number	:	480-759-3333
Fax Number	:

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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