MEDICARE: BENJAMIN R MENLOVE DDS PC

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	6361	AZ

General Provider Information

NPI Number	:	1457540023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENJAMIN R MENLOVE DDS PC

Provider Business Mailing Address
First Line	:	PO BOX 460
Second Line	:
City	:	HIGLEY
State	:	AZ
Zip	:	85236-0460
Country	:	US
Telephone Number	:	480-895-7979
Fax Number	:	480-895-2424

Provider Business Practice Location Address
First Line	:	3960 E RIGGS RD
Second Line	:	SUITE 2
City	:	CHANDLER
State	:	AZ
Zip	:	85249-5411
Country	:	US
Telephone Number	:	480-895-7979
Fax Number	:	480-895-2424

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BENJAMIN ROY MENLOVE
Credential	:	DDS
Telephone Number	:	480-747-4805

Provider Enumeration Date	:	10/19/2007
Last Update Date	:	10/19/2007

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