MEDICARE: DR. SCOTT HIDEO GOISHI 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	39800	CA

General Provider Information

NPI Number	:	1326182940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT HIDEO GOISHI D.D.S.

Provider Business Mailing Address
First Line	:	7461 N. FIRST
Second Line	:	SUITE 101
City	:	FRESNO
State	:	CA
Zip	:	93720
Country	:	US
Telephone Number	:	559-447-5014
Fax Number	:	559-447-5024

Provider Business Practice Location Address
First Line	:	7461 N 1ST ST
Second Line	:	SUITE 101
City	:	FRESNO
State	:	CA
Zip	:	93720-2850
Country	:	US
Telephone Number	:	559-447-5014
Fax Number	:	559-447-5024

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

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	07/08/2007

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