MEDICARE: DR. LOC THANH DAN 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
1	122300000X	Dentist	B40803	CA

General Provider Information

NPI Number	:	1467677732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOC THANH DAN DDS

Provider Business Mailing Address
First Line	:	14170 BROOKHURST ST
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-4658
Country	:	US
Telephone Number	:	714-638-8706
Fax Number	:	714-638-5349

Provider Business Practice Location Address
First Line	:	14170 BROOKHURST ST
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-4658
Country	:	US
Telephone Number	:	714-638-8706
Fax Number	:	714-638-5349

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

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	07/08/2007

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