MEDICARE: VILLAGE SQUARE DENTAL CENTER, INC.

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	46092	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386176790
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE SQUARE DENTAL CENTER, INC.

Provider Business Mailing Address
First Line	:	8265 VILLAGE PKWY
Second Line	:	STE. E
City	:	DUBLIN
State	:	CA
Zip	:	94568-1254
Country	:	US
Telephone Number	:	925-875-9700
Fax Number	:

Provider Business Practice Location Address
First Line	:	8265 VILLAGE PKWY
Second Line	:	STE. E
City	:	DUBLIN
State	:	CA
Zip	:	94568-1254
Country	:	US
Telephone Number	:	925-875-9700
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. MARIA LIGAYA BRAVO
Credential	:
Telephone Number	:	925-875-9700

Provider Enumeration Date	:	04/03/2017
Last Update Date	:	04/03/2017

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