MEDICARE: DR. ANTON BISBAS 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	29561	CA

General Provider Information

NPI Number	:	1306935234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTON BISBAS DDS

Provider Business Mailing Address
First Line	:	12750 CARMEL COUNTRY RD
Second Line	:	SUITE 202
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-2159
Country	:	US
Telephone Number	:	858-755-5363
Fax Number	:	858-755-1352

Provider Business Practice Location Address
First Line	:	12750 CARMEL COUNTRY RD
Second Line	:	SUITE 202
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-2159
Country	:	US
Telephone Number	:	858-755-5363
Fax Number	:	858-755-1352

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	07/08/2007

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