MEDICARE: RONALD FRANCIS ANTIMARINO DMD

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	27949	CA

General Provider Information

NPI Number	:	1396809018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD FRANCIS ANTIMARINO DMD

Provider Business Mailing Address
First Line	:	3816 WOODRUFF AVENUE
Second Line	:	SUITE 310
City	:	LONG BEACH
State	:	CA
Zip	:	90808-2146
Country	:	US
Telephone Number	:	562-421-9304
Fax Number	:	562-421-2363

Provider Business Practice Location Address
First Line	:	3816 WOODRUFF AVENUE
Second Line	:	SUITE 310
City	:	LONG BEACH
State	:	CA
Zip	:	90808-2146
Country	:	US
Telephone Number	:	562-421-9304
Fax Number	:	562-421-2363

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

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	07/08/2007

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