MEDICARE: DR. RONALD GREGORY SARLES 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	DD034897	CA

General Provider Information

NPI Number	:	1023232543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD GREGORY SARLES D.D.S

Provider Business Mailing Address
First Line	:	1301 BROADWAY
Second Line	:	6
City	:	MILLBRAE
State	:	CA
Zip	:	94030-1336
Country	:	US
Telephone Number	:	650-588-8850
Fax Number	:	650-588-2302

Provider Business Practice Location Address
First Line	:	1301 BROADWAY
Second Line	:	6
City	:	MILLBRAE
State	:	CA
Zip	:	94030-1336
Country	:	US
Telephone Number	:	650-588-8850
Fax Number	:	650-588-2302

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

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	07/08/2007

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