MEDICARE: DR. FRANCISCO C ENVERGA DDS

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	37413	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	37413	OTHER	CA	DENTAL LICENSE NO.
2	508330	OTHER	CA	UNITED CONCORDIA I. D.
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871502377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRANCISCO C ENVERGA DDS

Provider Business Mailing Address
First Line	:	2508 S GROVE AVE
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91761-6253
Country	:	US
Telephone Number	:	909-923-7881
Fax Number	:	909-923-7852

Provider Business Practice Location Address
First Line	:	2508 S GROVE AVE
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91761-6253
Country	:	US
Telephone Number	:	909-923-7881
Fax Number	:	909-923-7852

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	01/27/2011

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