MEDICARE: DR. ELLEN ANN VENTON 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	122300000X	Dentist	22929	CA

General Provider Information

NPI Number	:	1336241108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELLEN ANN VENTON DDS

Provider Business Mailing Address
First Line	:	296 ARLINGTON AVENUE
Second Line	:
City	:	KENSINGTON
State	:	CA
Zip	:	94707-1496
Country	:	US
Telephone Number	:	510-524-3236
Fax Number	:	510-524-1134

Provider Business Practice Location Address
First Line	:	296 ARLINGTON AVENUE
Second Line	:
City	:	KENSINGTON
State	:	CA
Zip	:	94707-1496
Country	:	US
Telephone Number	:	510-524-3236
Fax Number	:	510-524-1134

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

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	07/08/2007

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