MEDICARE: ASSOCIATED DENTAL CARE PROVIDERS, 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	:	1992848964
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSOCIATED DENTAL CARE PROVIDERS, LLC

Provider Business Mailing Address
First Line	:	14650 N DEL WEBB BLVD
Second Line	:
City	:	SUN CITY
State	:	AZ
Zip	:	85351-2147
Country	:	US
Telephone Number	:	623-876-8011
Fax Number	:	623-876-8902

Provider Business Practice Location Address
First Line	:	14650 N DEL WEBB BLVD
Second Line	:
City	:	SUN CITY
State	:	AZ
Zip	:	85351-2147
Country	:	US
Telephone Number	:	623-876-8011
Fax Number	:	623-876-8902

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	HANNAH FISH
Credential	:
Telephone Number	:	217-540-5699

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	09/18/2023

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