MEDICARE: CORTARO SMILES AND ORTHODONTICS, LLP

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	:	1518273598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORTARO SMILES AND ORTHODONTICS, LLP

Provider Business Mailing Address
First Line	:	2860 MICHELLE FL 2
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92606-1008
Country	:	US
Telephone Number	:	714-368-2077
Fax Number	:	714-368-2092

Provider Business Practice Location Address
First Line	:	8250 N CORTARO RD STE 110
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85743-7304
Country	:	US
Telephone Number	:	520-744-2233
Fax Number	:	520-744-5872

Authorized Official
Title or Position	:	CONTRACTS ADMIN
Name	:	DR. ERIC J SWENSEN
Credential	:	DDS
Telephone Number	:	520-744-2233

Provider Enumeration Date	:	08/27/2010
Last Update Date	:	08/27/2010

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8250 N CORTARO RD STE 110
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1275913543 — DR. MATTHEW NORTH HANNAN D.D.S.
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1962995167 — DR. SARAH LIU DMD
Practice Location Address:

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1689086639 — DR. CLAUDIA ALEJANDRA PATINO GONZALEZ MD
Practice Location Address:

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1144223660 — PICTURE ROCKS FIRE DISTRICT
Practice Location Address:

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