MEDICARE: DANIEL JEFFREY LONGACRE 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	28032	CA

General Provider Information

NPI Number	:	1649283466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL JEFFREY LONGACRE DDS

Provider Business Mailing Address
First Line	:	30131 TOWN CENTER DR
Second Line	:	SUITE 150
City	:	LAGUNA NIGUEL
State	:	CA
Zip	:	92677-2034
Country	:	US
Telephone Number	:	949-495-2000
Fax Number	:	949-495-1464

Provider Business Practice Location Address
First Line	:	30131 TOWN CENTER DR
Second Line	:	SUITE 150
City	:	LAGUNA NIGUEL
State	:	CA
Zip	:	92677-2034
Country	:	US
Telephone Number	:	949-495-2000
Fax Number	:	949-495-1464

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

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	07/08/2007

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