MEDICARE: MICHAEL D TRAYLOR 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	4559	AZ

General Provider Information

NPI Number	:	1922181429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL D TRAYLOR D.D.S.

Provider Business Mailing Address
First Line	:	13925 MEEKER BLVD. BLDG A,
Second Line	:	SUITE 6
City	:	SUN CITY WEST
State	:	AZ
Zip	:	85375
Country	:	US
Telephone Number	:	623-544-9600
Fax Number	:	623-544-9602

Provider Business Practice Location Address
First Line	:	13925 W MEEKER BLVD BLDG A
Second Line	:	SUITE 6
City	:	SUN CITY WEST
State	:	AZ
Zip	:	85375-4430
Country	:	US
Telephone Number	:	623-544-9600
Fax Number	:	623-544-9602

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

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	07/09/2007

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