MEDICARE: ENKATSU MANAGEMENT

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

General Provider Information

NPI Number	:	1427384916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENKATSU MANAGEMENT

Provider Business Mailing Address
First Line	:	8279 W LAKE PLEASANT PKWY
Second Line	:	SUITE 110
City	:	PEORIA
State	:	AZ
Zip	:	85382-7434
Country	:	US
Telephone Number	:	623-878-0120
Fax Number	:	623-825-6820

Provider Business Practice Location Address
First Line	:	8279 W LAKE PLEASANT PKWY
Second Line	:	SUITE 110
City	:	PEORIA
State	:	AZ
Zip	:	85382-7434
Country	:	US
Telephone Number	:	623-878-0120
Fax Number	:	623-825-6820

Authorized Official
Title or Position	:	OWNER
Name	:	MS. KIMBERLY A. MACK
Credential	:	R.D.H.
Telephone Number	:	480-231-7020

Provider Enumeration Date	:	10/19/2009
Last Update Date	:	10/19/2009

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Directions to “ENKATSU MANAGEMENT ” Practice Location

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