MEDICARE: MYINT SWE 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	122300000X	Dentist	52007	CA

General Provider Information

NPI Number	:	1770647836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYINT SWE DDS

Provider Business Mailing Address
First Line	:	89 RIDGEFIELD AVE
Second Line	:
City	:	DALY CITY
State	:	CA
Zip	:	94015-4235
Country	:	US
Telephone Number	:	650-755-4222
Fax Number	:

Provider Business Practice Location Address
First Line	:	1133 EL CAMINO REAL STE 3
Second Line	:
City	:	SOUTH SAN FRANCISCO
State	:	CA
Zip	:	94080-3288
Country	:	US
Telephone Number	:	650-952-3400
Fax Number	:	650-952-3499

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

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	04/27/2010

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