MEDICARE: DR. ROSARIO JOSEPH DESIMONE 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	1223G0001X	General Practice Dentistry	27267	CA

General Provider Information

NPI Number	:	1326164906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSARIO JOSEPH DESIMONE DDS

Provider Business Mailing Address
First Line	:	577 E ELDER ST
Second Line	:	STE A
City	:	FALLBROOK
State	:	CA
Zip	:	92028-3079
Country	:	US
Telephone Number	:	760-723-0787
Fax Number	:	760-723-2938

Provider Business Practice Location Address
First Line	:	577 E ELDER ST STE A
Second Line	:
City	:	FALLBROOK
State	:	CA
Zip	:	92028-3079
Country	:	US
Telephone Number	:	760-723-0787
Fax Number	:	760-723-2938

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	07/08/2007

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