MEDICARE: DR. JOHN LEWIS CUMMINGS DDS

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	122300000X	Dentist	34828	CA

General Provider Information

NPI Number	:	1205231644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN LEWIS CUMMINGS DDS

Provider Business Mailing Address
First Line	:	58457 29 PALMS HWY
Second Line	:
City	:	YUCCA VALLEY
State	:	CA
Zip	:	92284-5879
Country	:	US
Telephone Number	:	760-365-3338
Fax Number	:	760-365-5418

Provider Business Practice Location Address
First Line	:	58457 29 PALMS HWY
Second Line	:
City	:	YUCCA VALLEY
State	:	CA
Zip	:	92284-5879
Country	:	US
Telephone Number	:	760-365-3338
Fax Number	:	760-365-5418

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

Provider Enumeration Date	:	10/28/2014
Last Update Date	:	10/28/2014

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