MEDICARE: DENNIS S. EGUCHI, DDS, M.S. A 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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1184891558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENNIS S. EGUCHI, DDS, M.S. A DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	390 S GREEN VALLEY RD
Second Line	:	SUITE #3
City	:	WATSONVILLE
State	:	CA
Zip	:	95076-3077
Country	:	US
Telephone Number	:	831-728-0444
Fax Number	:	831-728-0445

Provider Business Practice Location Address
First Line	:	390 S GREEN VALLEY RD
Second Line	:	SUITE #3
City	:	WATSONVILLE
State	:	CA
Zip	:	95076-3077
Country	:	US
Telephone Number	:	831-728-0444
Fax Number	:	831-728-0445

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DENNIS S EGUCHI
Credential	:	D.D.S., M.S.
Telephone Number	:	831-728-0444

Provider Enumeration Date	:	05/14/2008
Last Update Date	:	05/14/2008

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