MEDICARE: SILVERTREE DENTISTRY

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1528452968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SILVERTREE DENTISTRY

Provider Business Mailing Address
First Line	:	1043 E MISSOURI AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-2663
Country	:	US
Telephone Number	:	602-216-0100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1043 E MISSOURI AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-2663
Country	:	US
Telephone Number	:	602-216-0100
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TZVETELINA MLADENOVA
Credential	:
Telephone Number	:	602-216-0100

Provider Enumeration Date	:	03/24/2015
Last Update Date	:	03/24/2015

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