MEDICARE: MY FAMILY DENTIST PC

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	D4560	AZ

General Provider Information

NPI Number	:	1568532570
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY FAMILY DENTIST PC

Provider Business Mailing Address
First Line	:	4517 N 32ND ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-3339
Country	:	US
Telephone Number	:	602-956-2280
Fax Number	:	602-956-0479

Provider Business Practice Location Address
First Line	:	4517 N 32ND ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-3339
Country	:	US
Telephone Number	:	602-956-2280
Fax Number	:	602-956-0479

Authorized Official
Title or Position	:	OWNER
Name	:	MR. GEORGE E EIFLER
Credential	:	DDS.MS
Telephone Number	:	602-956-2280

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	08/22/2020

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Directions to “MY FAMILY DENTIST PC ” Practice Location

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