MEDICARE: DR. THELMA CARDONA DAWANA DMD

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	54746	CA

General Provider Information

NPI Number	:	1053533869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THELMA CARDONA DAWANA DMD

Provider Business Mailing Address
First Line	:	995 MONTAGUE EXPY STE 112
Second Line	:
City	:	MILPITAS
State	:	CA
Zip	:	95035-6827
Country	:	US
Telephone Number	:	408-719-1005
Fax Number	:	408-907-9182

Provider Business Practice Location Address
First Line	:	995 MONTAGUE EXPY STE 112
Second Line	:
City	:	MILPITAS
State	:	CA
Zip	:	95035-6827
Country	:	US
Telephone Number	:	408-719-1005
Fax Number	:	408-907-9182

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

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	03/03/2008

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