MEDICARE: PHILIP ROBERT LETTS 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	43360	CA

General Provider Information

NPI Number	:	1417912346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP ROBERT LETTS DDS

Provider Business Mailing Address
First Line	:	751 S BASCOM AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95128-2604
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	90 HIGHLAND AVE
Second Line	:	VHC SAN MARTIN DENTAL CLINIC
City	:	SAN MARTIN
State	:	CA
Zip	:	95046-9504
Country	:	US
Telephone Number	:	408-686-2211
Fax Number	:

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

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	07/13/2007

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