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NPI Code Detail

MEDICARE: CONTINENTAL DENTAL CARE LLC

MEDICARE: CONTINENTAL DENTAL CARE 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
11223G0001XGeneral Practice DentistryF0213AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1965220OTHERAZAHCCCS

General Provider Information

NPI Number : 1972562965
Entity Type Code : Organization
Provider Name (Legal Business Name) : CONTINENTAL DENTAL CARE LLC
Provider Business Mailing Address
First Line : 5501 N 19TH AVE
Second Line : SUITE 103
City : PHOENIX
State : AZ
Zip : 85015-2450
Country : US
Telephone Number : 602-864-1119
Fax Number : 602-249-5080
Provider Business Practice Location Address
First Line : 5501 N 19TH AVE
Second Line : SUITE 103
City : PHOENIX
State : AZ
Zip : 85015-2450
Country : US
Telephone Number : 602-864-1119
Fax Number : 602-249-5080
Authorized Official
Title or Position : OWNER
Name : RUBEN E VAZQUEZ
Credential :
Telephone Number : 623-986-2606
Provider Enumeration Date : 03/20/2006
Last Update Date : 12/03/2009

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Directions to “CONTINENTAL DENTAL CARE LLC ” 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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