MEDICARE: TODD WEDEKING 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	122300000X	Dentist	50191	CA

General Provider Information

NPI Number	:	1235142787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TODD WEDEKING DDS

Provider Business Mailing Address
First Line	:	2201 BALFOUR RD
Second Line	:	SUITE D
City	:	BRENTWOOD
State	:	CA
Zip	:	94513-4927
Country	:	US
Telephone Number	:	925-516-8886
Fax Number	:	925-516-9876

Provider Business Practice Location Address
First Line	:	2201 BALFOUR RD
Second Line	:	SUITE D
City	:	BRENTWOOD
State	:	CA
Zip	:	94513-4927
Country	:	US
Telephone Number	:	925-516-8886
Fax Number	:	925-516-9876

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

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	07/08/2007

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