MEDICARE: DR. CRISTIAN AMADO SIERRA DMD

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	64345	CA
2	122300000X	Dentist	0000010092	TN

General Provider Information

NPI Number	:	1265849426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRISTIAN AMADO SIERRA DMD

Provider Business Mailing Address
First Line	:	5960 WEST MALL STE A
Second Line	:
City	:	ATASCADERO
State	:	CA
Zip	:	93422-4232
Country	:	US
Telephone Number	:	805-466-5787
Fax Number	:	805-466-6531

Provider Business Practice Location Address
First Line	:	5960 WEST MALL STE A
Second Line	:
City	:	ATASCADERO
State	:	CA
Zip	:	93422-4232
Country	:	US
Telephone Number	:	805-466-5787
Fax Number	:	805-466-6531

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

Provider Enumeration Date	:	07/18/2014
Last Update Date	:	12/13/2019

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