MEDICARE: TMJ DENTAL, 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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1598569113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TMJ DENTAL, PLLC

Provider Business Mailing Address
First Line	:	3603 W CORTARO FARMS RD STE 113
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85742-1219
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3603 W CORTARO FARMS RD STE 113
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85742-1219
Country	:	US
Telephone Number	:	520-572-1593
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	JAVIER M TAPIA
Credential	:	DMD
Telephone Number	:	520-572-1593

Provider Enumeration Date	:	04/02/2025
Last Update Date	:	04/02/2025

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