MEDICARE: PHOENIX DENTAL DESIGN, PLLC

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		AZ

General Provider Information

NPI Number	:	1689973141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX DENTAL DESIGN, PLLC

Provider Business Mailing Address
First Line	:	1440 E MISSOURI AVE
Second Line	:	SUITE 125
City	:	PHOENIX
State	:	AZ
Zip	:	85014-2458
Country	:	US
Telephone Number	:	602-956-2241
Fax Number	:

Provider Business Practice Location Address
First Line	:	1440 E MISSOURI AVE
Second Line	:	SUITE 125
City	:	PHOENIX
State	:	AZ
Zip	:	85014-2458
Country	:	US
Telephone Number	:	602-956-2241
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. EDWARD G BABITS
Credential	:	DDS
Telephone Number	:	602-956-2241

Provider Enumeration Date	:	03/23/2011
Last Update Date	:	03/23/2011

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