MEDICARE: AMERICAN IMPLANT CENTERS LLC

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	:	1891284709
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN IMPLANT CENTERS LLC

Provider Business Mailing Address
First Line	:	204B NEEL AVE
Second Line	:
City	:	SOCORRO
State	:	NM
Zip	:	87801-4649
Country	:	US
Telephone Number	:	267-318-6667
Fax Number	:

Provider Business Practice Location Address
First Line	:	724 MACDADE BLVD
Second Line	:
City	:	COLLINGDALE
State	:	PA
Zip	:	19023-3825
Country	:	US
Telephone Number	:	267-223-7052
Fax Number	:	505-226-9697

Authorized Official
Title or Position	:	OWNER
Name	:	GEORGE HANNA
Credential	:
Telephone Number	:	267-318-6667

Provider Enumeration Date	:	05/07/2018
Last Update Date	:	06/28/2023

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Directions to “AMERICAN IMPLANT CENTERS LLC ” Practice Location

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