MEDICARE: BI-LOW DENTAL SERVICE L.L.C.

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	122300000X	Dentist		AZ

General Provider Information

NPI Number	:	1780957639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BI-LOW DENTAL SERVICE L.L.C.

Provider Business Mailing Address
First Line	:	1902 NORTH 16TH STREET
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006
Country	:	US
Telephone Number	:	602-253-3459
Fax Number	:	602-253-5619

Provider Business Practice Location Address
First Line	:	1902 NORTH 16TH STREET
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006
Country	:	US
Telephone Number	:	602-253-3459
Fax Number	:	602-253-5619

Authorized Official
Title or Position	:	OWNER
Name	:	GUILLERMO ENRIQUE BARRIOS
Credential	:
Telephone Number	:	602-253-5774

Provider Enumeration Date	:	02/22/2012
Last Update Date	:	02/22/2012

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