MEDICARE: DR. THOMAS JAMES PRADE DDS

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	D7027	AZ

General Provider Information

NPI Number	:	1598837650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS JAMES PRADE DDS

Provider Business Mailing Address
First Line	:	11946 N. 144TH WAY
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85259
Country	:	US
Telephone Number	:	480-551-3535
Fax Number	:	480-551-3536

Provider Business Practice Location Address
First Line	:	13020 W RANCHO SANTA FE BLVD STE 102
Second Line	:
City	:	AVONDALE
State	:	AZ
Zip	:	85392-2002
Country	:	US
Telephone Number	:	623-536-0044
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	06/16/2023

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