MEDICARE: ANDREW TROSIEN DDS MS 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	42960	CA

General Provider Information

NPI Number	:	1114388311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDREW TROSIEN DDS MS INC

Provider Business Mailing Address
First Line	:	2850 N TRACY BLVD
Second Line	:	STE 300
City	:	TRACY
State	:	CA
Zip	:	95376-7767
Country	:	US
Telephone Number	:	209-833-1240
Fax Number	:	209-833-0699

Provider Business Practice Location Address
First Line	:	2850 N TRACY BLVD
Second Line	:	STE 300
City	:	TRACY
State	:	CA
Zip	:	95376-7767
Country	:	US
Telephone Number	:	209-833-1240
Fax Number	:	209-833-0699

Authorized Official
Title or Position	:	OWNER
Name	:	ANDREW TROSIEN
Credential	:
Telephone Number	:	209-833-1240

Provider Enumeration Date	:	03/15/2016
Last Update Date	:	03/18/2016

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