MEDICARE: XO DENTISTRY 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	122300000X	Dentist		AZ

General Provider Information

NPI Number	:	1538520119
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	XO DENTISTRY PLLC

Provider Business Mailing Address
First Line	:	3530 S VAL VISTA DR STE 201
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85297-7322
Country	:	US
Telephone Number	:	480-900-0001
Fax Number	:

Provider Business Practice Location Address
First Line	:	3530 S VAL VISTA DR STE 201
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85297-7322
Country	:	US
Telephone Number	:	480-900-0001
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	PAYAM ABEDI
Credential	:	DDS
Telephone Number	:	480-900-0001

Provider Enumeration Date	:	03/10/2016
Last Update Date	:	03/10/2016

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