MEDICARE: DR. ANDREW DWIGHT STYGAR DMD

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	034225	CA

General Provider Information

NPI Number	:	1851502330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW DWIGHT STYGAR DMD

Provider Business Mailing Address
First Line	:	637 S RANCHO SANTA FE RD
Second Line	:
City	:	SAN MARCOS
State	:	CA
Zip	:	92078-3973
Country	:	US
Telephone Number	:	760-744-8199
Fax Number	:	760-744-9162

Provider Business Practice Location Address
First Line	:	637 S RANCHO SANTA FE RD
Second Line	:
City	:	SAN MARCOS
State	:	CA
Zip	:	92078-3973
Country	:	US
Telephone Number	:	760-744-8199
Fax Number	:	760-744-9162

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

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	07/08/2007

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