MEDICARE: MATTHEW J CAVENDISH, DDS, 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	7383	AZ

General Provider Information

NPI Number	:	1508877051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATTHEW J CAVENDISH, DDS, PLLC

Provider Business Mailing Address
First Line	:	4646 E GREENWAY RD
Second Line	:	SUITE 102
City	:	PHOENIX
State	:	AZ
Zip	:	85032-4805
Country	:	US
Telephone Number	:	602-482-2785
Fax Number	:	602-482-7689

Provider Business Practice Location Address
First Line	:	4646 E GREENWAY RD
Second Line	:	SUITE 102
City	:	PHOENIX
State	:	AZ
Zip	:	85032-4805
Country	:	US
Telephone Number	:	602-482-2785
Fax Number	:	602-482-7689

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MATTHEW JAMES CAVENDISH
Credential	:	D.D.S.
Telephone Number	:	602-482-2785

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	10/29/2007

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