MEDICARE: A PAUL SERRANO DDS PC

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	D5543	AZ
2	332BC3200X	Customized Equipment (DME)
3	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	D2814	AZ

General Provider Information

NPI Number	:	1609989748
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A PAUL SERRANO DDS PC

Provider Business Mailing Address
First Line	:	1515 E MISSOURI
Second Line	:	STE 101
City	:	PHOENIX
State	:	AZ
Zip	:	85014-2443
Country	:	US
Telephone Number	:	602-274-7840
Fax Number	:	602-274-7956

Provider Business Practice Location Address
First Line	:	1515 E MISSOURI
Second Line	:	STE 101
City	:	PHOENIX
State	:	AZ
Zip	:	85014-2443
Country	:	US
Telephone Number	:	602-274-7840
Fax Number	:	602-274-7956

Authorized Official
Title or Position	:	OWNER/DDS
Name	:	MR. ALBERT PAUL SERRANO
Credential	:	DDS
Telephone Number	:	602-274-7840

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	12/02/2010

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