MEDICARE: DR. BILL GINZBURG 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	122300000X	Dentist	40241	CA

General Provider Information

NPI Number	:	1336360510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BILL GINZBURG D.D.S.

Provider Business Mailing Address
First Line	:	3130 S SEPULVEDA BLVD STE E
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-4214
Country	:	US
Telephone Number	:	310-268-0646
Fax Number	:	310-268-0536

Provider Business Practice Location Address
First Line	:	3130 S SEPULVEDA BLVD STE E
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-4214
Country	:	US
Telephone Number	:	310-268-0646
Fax Number	:	310-268-0536

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

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	07/08/2007

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