MEDICARE: RAGINI PORWAL 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	57493	CA

General Provider Information

NPI Number	:	1265688147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAGINI PORWAL D.D.S.

Provider Business Mailing Address
First Line	:	330 PARNASSUS AVE APT 307
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94117-3752
Country	:	US
Telephone Number	:	415-242-5657
Fax Number	:

Provider Business Practice Location Address
First Line	:	14850 HIGHWAY 4 STE B
Second Line	:
City	:	DISCOVERY BAY
State	:	CA
Zip	:	94505-2237
Country	:	US
Telephone Number	:	925-634-5353
Fax Number	:

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

Provider Enumeration Date	:	08/12/2008
Last Update Date	:	09/22/2019

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