MEDICARE: DR. MARK W JOINER 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	30566	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G93049	OTHER	CA	MEDI-CAL PROVIDER NUMBER

General Provider Information

NPI Number	:	1386655637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK W JOINER D.D.S.

Provider Business Mailing Address
First Line	:	1773 DOMINICAN WAY
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95065-1526
Country	:	US
Telephone Number	:	831-475-5500
Fax Number	:	831-475-0307

Provider Business Practice Location Address
First Line	:	1773 DOMINICAN WAY
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95065-1526
Country	:	US
Telephone Number	:	831-475-5500
Fax Number	:	831-475-0307

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	07/08/2007

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