MEDICARE: ALEJANDRA TAVERAS, DDS, P.C.

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	58328	CA

General Provider Information

NPI Number	:	1861798639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALEJANDRA TAVERAS, DDS, P.C.

Provider Business Mailing Address
First Line	:	7300 TOPANGA CANYON BLVD
Second Line	:	SUITE #6
City	:	CANOGA PARK
State	:	CA
Zip	:	91303-3333
Country	:	US
Telephone Number	:	818-884-4422
Fax Number	:	818-884-4773

Provider Business Practice Location Address
First Line	:	7300 TOPANGA CANYON BLVD
Second Line	:	SUITE #6
City	:	CANOGA PARK
State	:	CA
Zip	:	91303-3333
Country	:	US
Telephone Number	:	818-884-4422
Fax Number	:	818-884-4773

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. ALEJANDRA TAVERAS
Credential	:
Telephone Number	:	818-884-4422

Provider Enumeration Date	:	01/26/2011
Last Update Date	:	01/26/2011

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