MEDICARE: DUBLIN FAMILY DENTAL

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1437549417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DUBLIN FAMILY DENTAL

Provider Business Mailing Address
First Line	:	8265 VILLAGE PKWY
Second Line	:	SUITE A
City	:	DUBLIN
State	:	CA
Zip	:	94568-1254
Country	:	US
Telephone Number	:	925-833-0500
Fax Number	:

Provider Business Practice Location Address
First Line	:	8265 VILLAGE PKWY
Second Line	:	SUITE A
City	:	DUBLIN
State	:	CA
Zip	:	94568-1254
Country	:	US
Telephone Number	:	925-833-0500
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. CYNTHIA LAGASCA-IGNACIO
Credential	:	D.D.S.
Telephone Number	:	925-833-0500

Provider Enumeration Date	:	01/29/2015
Last Update Date	:	01/29/2015

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