MEDICARE: DR. DANIEL VINOGRAD 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	27393	CA

General Provider Information

NPI Number	:	1326360702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL VINOGRAD DDS

Provider Business Mailing Address
First Line	:	3830 VALLEY CENTRE DR # 705-151
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-3320
Country	:	US
Telephone Number	:	310-892-0505
Fax Number	:

Provider Business Practice Location Address
First Line	:	10450 FRIARS RD STE G
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-2311
Country	:	US
Telephone Number	:	310-892-0505
Fax Number	:

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

Provider Enumeration Date	:	02/25/2010
Last Update Date	:	10/15/2013

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