MEDICARE: LORRAINE O'CONNOR 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	50554	CA

General Provider Information

NPI Number	:	1396837365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORRAINE O'CONNOR DDS

Provider Business Mailing Address
First Line	:	470 CASTRO ST STE 206
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94114-2061
Country	:	US
Telephone Number	:	415-431-7900
Fax Number	:	415-431-7900

Provider Business Practice Location Address
First Line	:	470 CASTRO ST STE 206
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94114-2061
Country	:	US
Telephone Number	:	415-431-7900
Fax Number	:	415-431-7900

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	07/08/2007

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