MEDICARE: DR. BEN F TARSITANO D.D.S., 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	28822	CA
2	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	A50488	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558416065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BEN F TARSITANO D.D.S., M.D.

Provider Business Mailing Address
First Line	:	70 PENNY LN
Second Line	:	SUITE B
City	:	WATSONVILLE
State	:	CA
Zip	:	95076-6020
Country	:	US
Telephone Number	:	831-722-8887
Fax Number	:	831-722-2762

Provider Business Practice Location Address
First Line	:	70 PENNY LN
Second Line	:	SUITE B
City	:	WATSONVILLE
State	:	CA
Zip	:	95076-6020
Country	:	US
Telephone Number	:	831-722-8887
Fax Number	:	831-722-2762

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	12/11/2013

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