MEDICARE: AMEXUS MEXICO INC.

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	:	1043423742
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMEXUS MEXICO INC.

Provider Business Mailing Address
First Line	:	3045 S ARCHIBALD AVE
Second Line	:	SUITE H-289
City	:	ONTARIO
State	:	CA
Zip	:	91761-9001
Country	:	US
Telephone Number	:	909-758-8075
Fax Number	:

Provider Business Practice Location Address
First Line	:	3045 S ARCHIBALD AVE
Second Line	:	SUITE H-289
City	:	ONTARIO
State	:	CA
Zip	:	91761-9001
Country	:	US
Telephone Number	:	909-758-8075
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RICHARD TOVAR
Credential	:
Telephone Number	:	909-758-8075

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/29/2015

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