MEDICARE: DR. KATHERINE C ESLAO 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	42466	CA

General Provider Information

NPI Number	:	1184780959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHERINE C ESLAO D.D.S

Provider Business Mailing Address
First Line	:	2920 LYON ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94123-3226
Country	:	US
Telephone Number	:	415-921-1726
Fax Number	:	415-346-5798

Provider Business Practice Location Address
First Line	:	2920 LYON ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94123-3226
Country	:	US
Telephone Number	:	415-921-1726
Fax Number	:	415-346-5798

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

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	07/08/2007

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