MEDICARE: DR. JAMES REDFORD 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	0442000166	VA
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	63658	CA

General Provider Information

NPI Number	:	1376959536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES REDFORD D.D.S.

Provider Business Mailing Address
First Line	:	709 CENTER DR STE 101
Second Line	:
City	:	SAN MARCOS
State	:	CA
Zip	:	92069-2502
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	709 CENTER DR STE 101
Second Line	:
City	:	SAN MARCOS
State	:	CA
Zip	:	92069-2502
Country	:	US
Telephone Number	:	760-746-2045
Fax Number	:

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

Provider Enumeration Date	:	07/09/2014
Last Update Date	:	07/15/2014

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