MEDICARE: DR. CHRISTINE SIE D.D.S.

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	42837	CA

General Provider Information

NPI Number	:	1902923816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTINE SIE D.D.S.

Provider Business Mailing Address
First Line	:	2140 GRAND AVE
Second Line	:	SUITE 225
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-6800
Country	:	US
Telephone Number	:	909-364-8424
Fax Number	:	909-364-8417

Provider Business Practice Location Address
First Line	:	2140 GRAND AVE
Second Line	:	SUITE 225
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-6800
Country	:	US
Telephone Number	:	909-364-8424
Fax Number	:	909-364-8417

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

Provider Enumeration Date	:	03/24/2007
Last Update Date	:	07/08/2007

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