MEDICARE: DR. JAMES PETER PAPPAS D.D.S.

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	1223E0200X	Endodontics	43058	CA

General Provider Information

NPI Number	:	1346417201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES PETER PAPPAS D.D.S.

Provider Business Mailing Address
First Line	:	2050 HUNTINGTON DR
Second Line	:	SUITE A
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-4900
Country	:	US
Telephone Number	:	626-441-2975
Fax Number	:	626-285-7820

Provider Business Practice Location Address
First Line	:	2050 HUNTINGTON DR
Second Line	:	SUITE A
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-4900
Country	:	US
Telephone Number	:	626-441-2975
Fax Number	:	626-285-7820

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

Provider Enumeration Date	:	05/09/2008
Last Update Date	:	05/09/2008

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