MEDICARE: ARIZONA DENTAL SPECIALISTS

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	1223E0200X	Endodontics
2	1223P0300X	Periodontics

General Provider Information

NPI Number	:	1548284094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARIZONA DENTAL SPECIALISTS

Provider Business Mailing Address
First Line	:	7600 N 15TH ST STE 170
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-4305
Country	:	US
Telephone Number	:	602-870-1238
Fax Number	:	602-997-4951

Provider Business Practice Location Address
First Line	:	7600 N 15TH ST STE 170
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-4305
Country	:	US
Telephone Number	:	602-870-1238
Fax Number	:	602-997-4951

Authorized Official
Title or Position	:	ACCOUNTS RECIEVABLE SUPERVISOR
Name	:	DOROTHY LUGO
Credential	:
Telephone Number	:	602-870-1223

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	09/11/2025

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