MEDICARE: JOHN JOW 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	1223P0700X	Prosthodontics	25553	CA

General Provider Information

NPI Number	:	1750364287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN JOW DDS

Provider Business Mailing Address
First Line	:	1023 WIGET LANE
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94598
Country	:	US
Telephone Number	:	707-562-8225
Fax Number	:	707-562-8247

Provider Business Practice Location Address
First Line	:	2101 COURAGE DR
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-6717
Country	:	US
Telephone Number	:	707-784-2120
Fax Number	:

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

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	02/20/2013

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Directions to “ JOHN JOW DDS” Practice Location

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