MEDICARE: DR. JERRY DAVID MINSKY 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	31668	CA

General Provider Information

NPI Number	:	1184628539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERRY DAVID MINSKY D.D.S.

Provider Business Mailing Address
First Line	:	PO BOX 17430
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92817-7430
Country	:	US
Telephone Number	:	562-860-8330
Fax Number	:	714-363-5441

Provider Business Practice Location Address
First Line	:	6720 E SWARTHMORE DR
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92807-5041
Country	:	US
Telephone Number	:	562-860-8330
Fax Number	:	714-363-5441

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	10/05/2012

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