MEDICARE: DR. LIZA FARTASH 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	43950	CA

General Provider Information

NPI Number	:	1144341769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LIZA FARTASH D.D.S.

Provider Business Mailing Address
First Line	:	1582 NUTHATCH LN
Second Line	:
City	:	SUNNYVALE
State	:	CA
Zip	:	94087-4938
Country	:	US
Telephone Number	:	415-342-0801
Fax Number	:

Provider Business Practice Location Address
First Line	:	899 SIR FRANCIS DRAKE BLVD
Second Line	:
City	:	SAN ANSELMO
State	:	CA
Zip	:	94960-1916
Country	:	US
Telephone Number	:	415-482-9808
Fax Number	:

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

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	07/08/2007

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