MEDICARE: ALEC J TEMLOCK DENTAL CORPORATION

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	332BC3200X	Customized Equipment (DME)
2	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1144956293
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALEC J TEMLOCK DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	23911 DANZIG BAY
Second Line	:
City	:	DANA POINT
State	:	CA
Zip	:	92629-4407
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	23911 DANZIG BAY
Second Line	:
City	:	DANA POINT
State	:	CA
Zip	:	92629-4407
Country	:	US
Telephone Number	:	209-380-5486
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	ALEC TEMLOCK
Credential	:	DMD
Telephone Number	:	209-380-5486

Provider Enumeration Date	:	07/29/2022
Last Update Date	:	07/29/2022

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