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NPI Code Detail

MEDICARE: PASEO RANCH PEDIATRIC DENTISTRY AND ORTHODONTICS

MEDICARE: PASEO RANCH PEDIATRIC DENTISTRY AND ORTHODONTICS
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
1261QD0000XDental Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1861012023
Entity Type Code : Organization
Provider Name (Legal Business Name) : PASEO RANCH PEDIATRIC DENTISTRY AND ORTHODONTICS
Provider Business Mailing Address
First Line : 6677 W THUNDERBIRD RD STE A124
Second Line :
City : GLENDALE
State : AZ
Zip : 85306-3710
Country : US
Telephone Number : 623-223-9677
Fax Number :
Provider Business Practice Location Address
First Line : 6677 W THUNDERBIRD RD STE A124
Second Line :
City : GLENDALE
State : AZ
Zip : 85306-3710
Country : US
Telephone Number : 623-223-9677
Fax Number :
Authorized Official
Title or Position : DENTIST AND OWNER
Name : DR. MATHEW JENSEN
Credential : DMD
Telephone Number : 623-606-2217
Provider Enumeration Date : 04/17/2020
Last Update Date : 04/17/2020

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1568906089 — MRS. JAMIE HUTCHINSON FNP
Practice Location Address:
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Practice Location Address:
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1942884093 — DR. KARA ANN BENKOVICH DMD, MPH
Practice Location Address:
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Directions to “PASEO RANCH PEDIATRIC DENTISTRY AND ORTHODONTICS ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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