MEDICARE: DR. JOEL J BICKLER 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	122300000X	Dentist		CA

General Provider Information

NPI Number	:	1528260890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOEL J BICKLER D.D.S

Provider Business Mailing Address
First Line	:	PO BOX 250
Second Line	:
City	:	BIG BEAR CITY
State	:	CA
Zip	:	92314-0250
Country	:	US
Telephone Number	:	909-585-7444
Fax Number	:	909-585-6965

Provider Business Practice Location Address
First Line	:	1012 WEST BIG BEAR BLVD
Second Line	:
City	:	BIG BEAR CITY
State	:	CA
Zip	:	92314
Country	:	US
Telephone Number	:	909-585-7444
Fax Number	:	909-585-6965

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

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	07/08/2007

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