MEDICARE: AFFORDABLE DENTURES & IMPLANTS - AVONDALE III, P.C.

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

General Provider Information

NPI Number	:	1598617268
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFORDABLE DENTURES & IMPLANTS - AVONDALE III, P.C.

Provider Business Mailing Address
First Line	:	1619 N DYSART RD STE 105
Second Line	:
City	:	AVONDALE
State	:	AZ
Zip	:	85392-1200
Country	:	US
Telephone Number	:	623-688-5596
Fax Number	:

Provider Business Practice Location Address
First Line	:	1619 N DYSART RD STE 105
Second Line	:
City	:	AVONDALE
State	:	AZ
Zip	:	85392-1200
Country	:	US
Telephone Number	:	623-688-5596
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JUSTIN MOODY
Credential	:	DDS
Telephone Number	:	623-688-5596

Provider Enumeration Date	:	02/13/2026
Last Update Date	:	02/13/2026

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