MEDICARE: MS. IRENE CHUA LIMTAO 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	1223G0001X	General Practice Dentistry	38870	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B3887001	OTHER	CA	DENTI CAL

General Provider Information

NPI Number	:	1346312725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. IRENE CHUA LIMTAO DDS

Provider Business Mailing Address
First Line	:	463 N CENTRAL AVENUE
Second Line	:
City	:	UPLAND
State	:	CA
Zip	:	91786-4219
Country	:	US
Telephone Number	:	909-949-4578
Fax Number	:	909-949-4578

Provider Business Practice Location Address
First Line	:	463 N CENTRAL AVENUE
Second Line	:
City	:	UPLAND
State	:	CA
Zip	:	91786-4219
Country	:	US
Telephone Number	:	909-949-4578
Fax Number	:	909-949-4578

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

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	07/08/2007

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