MEDICARE: DENTAL ONE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	122300000X	Dentist
2	1223E0200X	Endodontics
3	1223P0221X	Pediatric Dentistry
4	1223P0300X	Periodontics
5	1223P0700X	Prosthodontics
6	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry
7	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1578706891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL ONE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 860036
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55486-0036
Country	:	US
Telephone Number	:	602-268-1655
Fax Number	:	216-584-1310

Provider Business Practice Location Address
First Line	:	2434 E. BASELINE RD.
Second Line	:	SUITE 104
City	:	PHOENIX
State	:	AZ
Zip	:	85042-7088
Country	:	US
Telephone Number	:	602-268-1655
Fax Number	:	216-584-1310

Authorized Official
Title or Position	:	DIRECTOR, RCM
Name	:	LAUREN HILL
Credential	:
Telephone Number	:	972-930-7707

Provider Enumeration Date	:	04/16/2009
Last Update Date	:	06/16/2022

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Directions to “DENTAL ONE, INC. ” Practice Location

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