MEDICARE: STEFAN MOICEANU D.D.S.

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	43820	CA

General Provider Information

NPI Number	:	1174528590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEFAN MOICEANU D.D.S.

Provider Business Mailing Address
First Line	:	2970 HILLTOP MALL RD
Second Line	:	STE 211
City	:	RICHMOND
State	:	CA
Zip	:	94806-1949
Country	:	US
Telephone Number	:	510-758-7222
Fax Number	:	510-758-7741

Provider Business Practice Location Address
First Line	:	2970 HILLTOP MALL RD
Second Line	:	STE 211
City	:	RICHMOND
State	:	CA
Zip	:	94806-1949
Country	:	US
Telephone Number	:	510-758-7222
Fax Number	:	510-758-7741

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	07/08/2007

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