=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407085749
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | OSCAR A GOCHEZ DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2009
-----------------------------------------------------
Last Update Date | 07/08/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12716 S. CENTRAL AVE
-----------------------------------------------------
City | CHINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-628-5133
-----------------------------------------------------
Fax | 909-628-2938
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12716 S. CENTRAL AVE
-----------------------------------------------------
City | CHINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-628-5133
-----------------------------------------------------
Fax | 909-628-2938
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 35109
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------