MEDICARE: DR. NIKOLA J BAN 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	1223G0001X	General Practice Dentistry	45430	CA

General Provider Information

NPI Number	:	1427277870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NIKOLA J BAN D.D.S.

Provider Business Mailing Address
First Line	:	10723 RIVERSIDE DR
Second Line	:
City	:	TOLUCA LAKE
State	:	CA
Zip	:	91602-2312
Country	:	US
Telephone Number	:	818-760-8108
Fax Number	:	818-760-4356

Provider Business Practice Location Address
First Line	:	10723 RIVERSIDE DR
Second Line	:
City	:	TOLUCA LAKE
State	:	CA
Zip	:	91602-2312
Country	:	US
Telephone Number	:	818-760-8108
Fax Number	:	818-760-4356

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

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	07/08/2007

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