MEDICARE: JCWEST DMD 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	1223P0221X	Pediatric Dentistry	D007997	AZ

General Provider Information

NPI Number	:	1528504628
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JCWEST DMD PLLC

Provider Business Mailing Address
First Line	:	4046 E PALO VERDE ST
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85296-1174
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2040 E BROWN RD
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85213-5222
Country	:	US
Telephone Number	:	480-250-5843
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	JOHN CAMPBELL WEST
Credential	:	DMD
Telephone Number	:	480-250-5843

Provider Enumeration Date	:	01/12/2017
Last Update Date	:	01/12/2017

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