MEDICARE: DR. ELYSA PRUZANSKY DANIELS D.D.S.

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	3466	AZ

General Provider Information

NPI Number	:	1396737060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELYSA PRUZANSKY DANIELS D.D.S.

Provider Business Mailing Address
First Line	:	7518 ELBOW BEND RD
Second Line	:	SUITE #1
City	:	CAREFREE
State	:	AZ
Zip	:	85377-2268
Country	:	US
Telephone Number	:	480-488-9735
Fax Number	:	480-575-1427

Provider Business Practice Location Address
First Line	:	7518 ELBOW BEND RD
Second Line	:	SUITE #1
City	:	CAREFREE
State	:	AZ
Zip	:	85377-2268
Country	:	US
Telephone Number	:	480-488-9735
Fax Number	:	480-575-1427

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

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	09/07/2007

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