MEDICARE: BRUCE SHINTARO ABE 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	1223P0300X	Periodontics	47344	CA

General Provider Information

NPI Number	:	1235104688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE SHINTARO ABE D.D.S.

Provider Business Mailing Address
First Line	:	501 WASHINGTON ST STE 740
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-2231
Country	:	US
Telephone Number	:	619-417-9910
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 WASHINGTON ST STE 740
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-2231
Country	:	US
Telephone Number	:	619-393-7511
Fax Number	:

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

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	09/25/2023

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