MEDICARE: GREGORY MICHAEL ROOS 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	27061	CA

General Provider Information

NPI Number	:	1336293869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY MICHAEL ROOS DMD

Provider Business Mailing Address
First Line	:	51 RENATO COURT SUITE C
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94061-4017
Country	:	US
Telephone Number	:	650-366-3812
Fax Number	:	650-365-3135

Provider Business Practice Location Address
First Line	:	51 RENATO COURT SUITE C
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94061-4017
Country	:	US
Telephone Number	:	650-366-3812
Fax Number	:	650-365-3135

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	07/08/2007

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