MEDICARE: DR. HERMES BUSTOS MALLARI 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	122300000X	Dentist	52427	CA

General Provider Information

NPI Number	:	1033177407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HERMES BUSTOS MALLARI D.D.S.

Provider Business Mailing Address
First Line	:	2246 GOLD ST
Second Line	:
City	:	REDDING
State	:	CA
Zip	:	96001-2419
Country	:	US
Telephone Number	:	530-246-3381
Fax Number	:

Provider Business Practice Location Address
First Line	:	2147 COURT ST
Second Line	:
City	:	REDDING
State	:	CA
Zip	:	96001-2531
Country	:	US
Telephone Number	:	530-246-4100
Fax Number	:

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. HERMES BUSTOS MALLARI D.D.S.” Practice Location

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