MEDICARE: SPECIAL DENTAL HYGIENE CARE, 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
1	122300000X	Dentist	23533	CA

General Provider Information

NPI Number	:	1801038542
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIAL DENTAL HYGIENE CARE, INC.

Provider Business Mailing Address
First Line	:	16470 W LA CHIQUITA AVE
Second Line	:
City	:	LOS GATOS
State	:	CA
Zip	:	95032-4635
Country	:	US
Telephone Number	:	408-358-0209
Fax Number	:	408-358-3670

Provider Business Practice Location Address
First Line	:	16470 W LA CHIQUITA AVE
Second Line	:
City	:	LOS GATOS
State	:	CA
Zip	:	95032-4635
Country	:	US
Telephone Number	:	408-358-0209
Fax Number	:	408-358-3670

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. LAUREL E. LOOMER
Credential	:	RDHAP
Telephone Number	:	408-358-0209

Provider Enumeration Date	:	03/26/2009
Last Update Date	:	03/26/2009

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