MEDICARE: JURINA SMIDA 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	261QD0000X	Dental Clinic/Center		CA

General Provider Information

NPI Number	:	1942681937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JURINA SMIDA DDS

Provider Business Mailing Address
First Line	:	26 4TH ST
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94952-3040
Country	:	US
Telephone Number	:	707-789-9151
Fax Number	:

Provider Business Practice Location Address
First Line	:	26 4TH ST
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94952-3040
Country	:	US
Telephone Number	:	707-789-9151
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	SORAIYA SMIDA
Credential	:
Telephone Number	:	707-789-9151

Provider Enumeration Date	:	06/15/2015
Last Update Date	:	06/15/2015

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