MEDICARE: DOUGLAS ALLEN PULSIPHER D.D.S.

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	3246	AZ

General Provider Information

NPI Number	:	1871759043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS ALLEN PULSIPHER D.D.S.

Provider Business Mailing Address
First Line	:	4350 E RAY RD
Second Line	:	SUITE 116
City	:	PHOENIX
State	:	AZ
Zip	:	85044-4703
Country	:	US
Telephone Number	:	480-706-0789
Fax Number	:

Provider Business Practice Location Address
First Line	:	4350 E RAY RD
Second Line	:	SUITE 116
City	:	PHOENIX
State	:	AZ
Zip	:	85044-4703
Country	:	US
Telephone Number	:	480-706-0789
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2008
Last Update Date	:	08/06/2008

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