MEDICARE: OBADIAH MICHAEL ALLMARAS 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	122300000X	Dentist	6435-15	WI
2	122300000X	Dentist	64101	CA

General Provider Information

NPI Number	:	1225364680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OBADIAH MICHAEL ALLMARAS D.D.S.

Provider Business Mailing Address
First Line	:	250 N COLLEGE PARK DR
Second Line	:	APT N36
City	:	UPLAND
State	:	CA
Zip	:	91786-8883
Country	:	US
Telephone Number	:	918-628-2528
Fax Number	:

Provider Business Practice Location Address
First Line	:	3551 PECK RD
Second Line	:	SUITE 101
City	:	EL MONTE
State	:	CA
Zip	:	91731-3547
Country	:	US
Telephone Number	:	918-628-2528
Fax Number	:

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

Provider Enumeration Date	:	10/20/2009
Last Update Date	:	02/07/2018

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