MEDICARE: DR. JOHN MASSOUD D.M.D.

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	60175	CA

General Provider Information

NPI Number	:	1477859312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN MASSOUD D.M.D.

Provider Business Mailing Address
First Line	:	1680 WESTWOOD DR
Second Line	:	SUITE B
City	:	SAN JOSE
State	:	CA
Zip	:	95125-5105
Country	:	US
Telephone Number	:	408-266-6811
Fax Number	:

Provider Business Practice Location Address
First Line	:	1670 WESTWOOD DR
Second Line	:	SUITE J
City	:	SAN JOSE
State	:	CA
Zip	:	95125-5111
Country	:	US
Telephone Number	:	408-266-6811
Fax Number	:

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

Provider Enumeration Date	:	02/09/2011
Last Update Date	:	10/27/2016

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