MEDICARE: ASSOCIATED DENTAL CARE PROVIDERS, LLC

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	:	1609069574
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSOCIATED DENTAL CARE PROVIDERS, LLC

Provider Business Mailing Address
First Line	:	3773 W INA RD
Second Line	:	SUITE 180
City	:	TUCSON
State	:	AZ
Zip	:	85741-2246
Country	:	US
Telephone Number	:	520-579-8166
Fax Number	:

Provider Business Practice Location Address
First Line	:	3773 W INA RD
Second Line	:	SUITE 180
City	:	TUCSON
State	:	AZ
Zip	:	85741-2246
Country	:	US
Telephone Number	:	520-579-8166
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	HANNAH FISH
Credential	:
Telephone Number	:	217-540-5699

Provider Enumeration Date	:	08/23/2007
Last Update Date	:	09/18/2023

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