MEDICARE: UNIVERSITY OF THE PACIFIC ARTHUR A. DUGONI SCHOOL OF DENTISTRY

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

General Provider Information

NPI Number	:	1265263842
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF THE PACIFIC ARTHUR A. DUGONI SCHOOL OF DENTISTRY

Provider Business Mailing Address
First Line	:	3333 3RD AVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95817-2808
Country	:	US
Telephone Number	:	916-672-2774
Fax Number	:

Provider Business Practice Location Address
First Line	:	3333 3RD AVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95817-2808
Country	:	US
Telephone Number	:	916-672-2774
Fax Number	:

Authorized Official
Title or Position	:	ASSOC. DEAN OF BUDGET AND FINANCE
Name	:	ED PEGUEROS
Credential	:
Telephone Number	:	415-351-7192

Provider Enumeration Date	:	08/13/2024
Last Update Date	:	04/03/2025

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