MEDICARE: DR. PETER JR. SPENNATO 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	122300000X	Dentist	40020	CA

General Provider Information

NPI Number	:	1629253810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER JR. SPENNATO D.D.S.

Provider Business Mailing Address
First Line	:	1411 W 8TH ST
Second Line	:
City	:	SAN PEDRO
State	:	CA
Zip	:	90732-3803
Country	:	US
Telephone Number	:	310-832-5559
Fax Number	:	310-832-9187

Provider Business Practice Location Address
First Line	:	1411 W 8TH ST
Second Line	:
City	:	SAN PEDRO
State	:	CA
Zip	:	90732-3803
Country	:	US
Telephone Number	:	310-832-5559
Fax Number	:	310-832-9187

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

Provider Enumeration Date	:	01/07/2008
Last Update Date	:	01/07/2008

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