MEDICARE: PLEASANT VALLEY DENTISTRY, PLLC

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	5928	AZ

General Provider Information

NPI Number	:	1477708774
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLEASANT VALLEY DENTISTRY, PLLC

Provider Business Mailing Address
First Line	:	9784 W YEARLING RD
Second Line	:	#1500
City	:	PEORIA
State	:	AZ
Zip	:	85383-1379
Country	:	US
Telephone Number	:	623-561-1470
Fax Number	:	623-561-1169

Provider Business Practice Location Address
First Line	:	9784 W YEARLING RD
Second Line	:	#1500
City	:	PEORIA
State	:	AZ
Zip	:	85383-1379
Country	:	US
Telephone Number	:	623-561-1470
Fax Number	:	623-561-1169

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. IVAN DARIO TOVAR
Credential	:	D.D.S.
Telephone Number	:	623-561-1470

Provider Enumeration Date	:	12/01/2008
Last Update Date	:	12/01/2008

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