MEDICARE: DR. SUSAN CANE DDS, MA, BS

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	62545	CA

General Provider Information

NPI Number	:	1801222344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN CANE DDS, MA, BS

Provider Business Mailing Address
First Line	:	11771 MONTANA AVE
Second Line	:	#212
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-6716
Country	:	US
Telephone Number	:	818-926-2036
Fax Number	:

Provider Business Practice Location Address
First Line	:	11771 MONTANA AVE
Second Line	:	#212
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-6716
Country	:	US
Telephone Number	:	818-926-2036
Fax Number	:

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

Provider Enumeration Date	:	09/16/2013
Last Update Date	:	09/16/2013

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