MEDICARE: DR. ALLISON BORDEN HOUSE DMD

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	D5268	AZ

General Provider Information

NPI Number	:	1487752101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLISON BORDEN HOUSE DMD

Provider Business Mailing Address
First Line	:	5033 N 44TH ST
Second Line	:	SUITE C-9
City	:	PHOENIX
State	:	AZ
Zip	:	85018-1622
Country	:	US
Telephone Number	:	602-957-4576
Fax Number	:	602-957-4579

Provider Business Practice Location Address
First Line	:	5033 N 44TH ST
Second Line	:	SUITE C-9
City	:	PHOENIX
State	:	AZ
Zip	:	85018-1622
Country	:	US
Telephone Number	:	602-957-4576
Fax Number	:	602-957-4579

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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