MEDICARE: DR. DUSTIN L. ROWE 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	38221	CA

General Provider Information

NPI Number	:	1215959671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DUSTIN L. ROWE D.D.S.

Provider Business Mailing Address
First Line	:	3320 N LOS COYOTES DIAGONAL
Second Line	:	SUITE 100
City	:	LONG BEACH
State	:	CA
Zip	:	90808-3918
Country	:	US
Telephone Number	:	562-496-0111
Fax Number	:	562-496-1773

Provider Business Practice Location Address
First Line	:	3320 N LOS COYOTES DIAGONAL
Second Line	:	SUITE 100
City	:	LONG BEACH
State	:	CA
Zip	:	90808-3918
Country	:	US
Telephone Number	:	562-496-0111
Fax Number	:	562-496-1773

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	07/08/2007

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