MEDICARE: DR. WOJCIECH ANDRE JASKIEWICZ 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	032326	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B32326-01	OTHER	CA	DENTI-CAL

General Provider Information

NPI Number	:	1215050042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WOJCIECH ANDRE JASKIEWICZ D.D.S.

Provider Business Mailing Address
First Line	:	550 N LARCHMONT BLVD
Second Line	:	SUITE 103
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-1318
Country	:	US
Telephone Number	:	323-461-7955
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 N LARCHMONT BLVD
Second Line	:	SUITE 103
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-1318
Country	:	US
Telephone Number	:	323-461-7955
Fax Number	:

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

Provider Enumeration Date	:	04/08/2007
Last Update Date	:	07/08/2007

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