MEDICARE: CAMARILLO SPRINGS DENTAL

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	1223G0001X	General Practice Dentistry	64693	CA

General Provider Information

NPI Number	:	1144605775
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAMARILLO SPRINGS DENTAL

Provider Business Mailing Address
First Line	:	816 CAMARILLO SPRINGS RD STE L
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93012-9441
Country	:	US
Telephone Number	:	805-388-3008
Fax Number	:	805-388-5033

Provider Business Practice Location Address
First Line	:	816 CAMARILLO SPRINGS RD STE L
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93012-9441
Country	:	US
Telephone Number	:	805-388-3008
Fax Number	:	805-388-5033

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. MICHELLE PEDONE
Credential	:
Telephone Number	:	805-388-3008

Provider Enumeration Date	:	07/24/2015
Last Update Date	:	07/24/2015

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Directions to “CAMARILLO SPRINGS DENTAL ” Practice Location

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