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NPI Code Detail

MEDICARE: MARY ELIZABETH FIEDLER DDS

MEDICARE: MARY ELIZABETH FIEDLER DDS
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
1122300000XDentist36149CA

General Provider Information

NPI Number : 1437285954
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY ELIZABETH FIEDLER DDS
Provider Business Mailing Address
First Line : 30131 TOWN CENTER DRIVE STE 138
Second Line :
City : LAGUNA NIGUEL
State : CA
Zip : 92677-2010
Country : US
Telephone Number : 949-249-3473
Fax Number : 949-249-3494
Provider Business Practice Location Address
First Line : 30131 TOWN CENTER DRIVE SUITE 138
Second Line :
City : LAGUNA NIGUEL
State : CA
Zip : 92677-2010
Country : US
Telephone Number : 949-249-3473
Fax Number : 949-249-3494
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2007
Last Update Date : 07/08/2007

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