MEDICARE: DR. JAMES R CHAFFIN DDS

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	6119	AZ

General Provider Information

NPI Number	:	1972621282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES R CHAFFIN DDS

Provider Business Mailing Address
First Line	:	4025 W BELL RD
Second Line	:	SUITE 7
City	:	PHOENIX
State	:	AZ
Zip	:	85053-2750
Country	:	US
Telephone Number	:	602-978-6496
Fax Number	:	602-978-1338

Provider Business Practice Location Address
First Line	:	4025 W BELL RD
Second Line	:	SUITE 7
City	:	PHOENIX
State	:	AZ
Zip	:	85053-2750
Country	:	US
Telephone Number	:	602-978-6496
Fax Number	:	602-978-1338

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/08/2007

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