MEDICARE: DR. BYRON VREELAND

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	15608	CA

General Provider Information

NPI Number	:	1811369945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BYRON VREELAND

Provider Business Mailing Address
First Line	:	10514 HEBRON LN
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90077-2722
Country	:	US
Telephone Number	:	310-474-8755
Fax Number	:

Provider Business Practice Location Address
First Line	:	10514 HEBRON LN
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90077-2722
Country	:	US
Telephone Number	:	310-474-8755
Fax Number	:

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

Provider Enumeration Date	:	10/28/2015
Last Update Date	:	10/28/2015

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Directions to “ DR. BYRON VREELAND ” Practice Location

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