MEDICARE: DR. DILBER SINGH SRAON 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	44094	CA

General Provider Information

NPI Number	:	1588873566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DILBER SINGH SRAON D.D.S.

Provider Business Mailing Address
First Line	:	6105 SNELL AVE
Second Line	:	SUITE 100
City	:	SAN JOSE
State	:	CA
Zip	:	95123-4739
Country	:	US
Telephone Number	:	408-227-1404
Fax Number	:	408-227-8346

Provider Business Practice Location Address
First Line	:	6105 SNELL AVE
Second Line	:	SUITE 100
City	:	SAN JOSE
State	:	CA
Zip	:	95123-4739
Country	:	US
Telephone Number	:	408-227-1404
Fax Number	:	408-227-8346

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/08/2007

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