MEDICARE: DR. JEROME NEREZ RAGADIO 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	122300000X	Dentist	51638	CA

General Provider Information

NPI Number	:	1043295678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEROME NEREZ RAGADIO D.D.S.

Provider Business Mailing Address
First Line	:	3538 BOUGAINVILLE RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92155-5491
Country	:	US
Telephone Number	:	619-437-2954
Fax Number	:	619-437-5658

Provider Business Practice Location Address
First Line	:	3538 BOUGAINVILLE RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92155-5491
Country	:	US
Telephone Number	:	619-437-2954
Fax Number	:	619-437-5658

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

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	06/10/2008

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