MEDICARE: NEW AGE DENTAL

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

General Provider Information

NPI Number	:	1972713279
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW AGE DENTAL

Provider Business Mailing Address
First Line	:	25937 THE OLD RD
Second Line	:
City	:	STEVENSON RANCH
State	:	CA
Zip	:	91381-1714
Country	:	US
Telephone Number	:	661-799-1991
Fax Number	:	661-799-9238

Provider Business Practice Location Address
First Line	:	25937 THE OLD RD
Second Line	:
City	:	STEVENSON RANCH
State	:	CA
Zip	:	91381-1714
Country	:	US
Telephone Number	:	661-799-1991
Fax Number	:	661-799-9238

Authorized Official
Title or Position	:	OWNER
Name	:	DR. EDMOND M. TASH
Credential	:	DDS
Telephone Number	:	661-799-1991

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/10/2008

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Directions to “NEW AGE DENTAL ” Practice Location

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