MEDICARE: DR. DONALD BRUCE MCETCHIN 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	29082	CA

General Provider Information

NPI Number	:	1548254824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD BRUCE MCETCHIN DDS

Provider Business Mailing Address
First Line	:	3309 LAKESHORE AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94610-2305
Country	:	US
Telephone Number	:	510-444-4331
Fax Number	:	510-444-4331

Provider Business Practice Location Address
First Line	:	3309 LAKESHORE AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94610-2305
Country	:	US
Telephone Number	:	510-444-4331
Fax Number	:	510-444-4331

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

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	07/08/2007

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