MEDICARE: DR. JOHN DIGIOVANNI D.D.S.,M.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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	39146	CA

General Provider Information

NPI Number	:	1326257270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN DIGIOVANNI D.D.S.,M.S.

Provider Business Mailing Address
First Line	:	1166 GLENNEYRE ST
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-2908
Country	:	US
Telephone Number	:	949-494-8555
Fax Number	:	949-494-7671

Provider Business Practice Location Address
First Line	:	1166 GLENNEYRE ST
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-2908
Country	:	US
Telephone Number	:	949-494-8555
Fax Number	:	949-494-7671

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	05/02/2018

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