MEDICARE: RYAN HUPKA DDS

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	61848	CA

General Provider Information

NPI Number	:	1205185493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN HUPKA DDS

Provider Business Mailing Address
First Line	:	2626 S LOWELL ST
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92707-3307
Country	:	US
Telephone Number	:	714-350-9998
Fax Number	:

Provider Business Practice Location Address
First Line	:	2626 S LOWELL ST
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92707-3307
Country	:	US
Telephone Number	:	714-350-9998
Fax Number	:

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

Provider Enumeration Date	:	09/03/2012
Last Update Date	:	09/03/2012

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