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NPI Code Detail

MEDICARE: DOUGLAS W. VIERRA, D.D.S., INC.

MEDICARE: DOUGLAS W. VIERRA, D.D.S., INC.
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
11223G0001XGeneral Practice Dentistry40148CA
21223S0112XOral and Maxillofacial Surgery (Dentist)55364CA
31223G0001XGeneral Practice Dentistry32626CA

General Provider Information

NPI Number : 1689960809
Entity Type Code : Organization
Provider Name (Legal Business Name) : DOUGLAS W. VIERRA, D.D.S., INC.
Provider Business Mailing Address
First Line : 4205 SAN FELIPE ROAD
Second Line : SUITE 200
City : SAN JOSE
State : CA
Zip : 95135-1505
Country : US
Telephone Number : 408-270-4333
Fax Number : 408-270-3373
Provider Business Practice Location Address
First Line : 4205 SAN FELIPE RD
Second Line : SUITE 200
City : SAN JOSE
State : CA
Zip : 95135-1505
Country : US
Telephone Number : 408-270-4333
Fax Number : 408-270-3373
Authorized Official
Title or Position : PRESIDENT
Name : DR. DOUGLAS W VIERRA
Credential : D.D.S.
Telephone Number : 408-270-4333
Provider Enumeration Date : 06/27/2011
Last Update Date : 06/27/2011

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Directions to “DOUGLAS W. VIERRA, D.D.S., INC. ” Practice Location

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