MEDICARE: ALFRED PHEN 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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1649134214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALFRED PHEN DDS PC

Provider Business Mailing Address
First Line	:	515 ADOBE RD
Second Line	:
City	:	RED BLUFF
State	:	CA
Zip	:	96080-9623
Country	:	US
Telephone Number	:	530-527-4440
Fax Number	:	530-528-8758

Provider Business Practice Location Address
First Line	:	515 ADOBE RD
Second Line	:
City	:	RED BLUFF
State	:	CA
Zip	:	96080-9623
Country	:	US
Telephone Number	:	530-527-4440
Fax Number	:	530-528-8758

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	DAWN NOBLE
Credential	:
Telephone Number	:	530-527-4440

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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