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NPI Code Detail

MEDICARE: EBW DMD PLLC

MEDICARE: EBW DMD PLLC
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/Center8491AZ

General Provider Information

NPI Number : 1922594522
Entity Type Code : Organization
Provider Name (Legal Business Name) : EBW DMD PLLC
Provider Business Mailing Address
First Line : 14800 W MOUNTAIN VIEW BLVD STE 200
Second Line :
City : SURPRISE
State : AZ
Zip : 85374-2703
Country : US
Telephone Number : 623-933-5749
Fax Number :
Provider Business Practice Location Address
First Line : 14800 W MOUNTAIN VIEW BLVD STE 200
Second Line :
City : SURPRISE
State : AZ
Zip : 85374-2703
Country : US
Telephone Number : 623-933-5749
Fax Number :
Authorized Official
Title or Position : DENTIST
Name : DR. ERIC WENDELSCHAFER
Credential : DMD
Telephone Number : 480-606-2630
Provider Enumeration Date : 07/06/2018
Last Update Date : 07/06/2018

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