MEDICARE: BEDFORD DENTAL GROUP

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	54639	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1558419929	OTHER	CA	ALL INSURANCE COMPANIES

General Provider Information

NPI Number	:	1528456589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEDFORD DENTAL GROUP

Provider Business Mailing Address
First Line	:	PO BOX 17099
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90209-3099
Country	:	US
Telephone Number	:	310-278-0600
Fax Number	:

Provider Business Practice Location Address
First Line	:	436 N BEDFORD DR STE 300
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-4320
Country	:	US
Telephone Number	:	310-278-0600
Fax Number	:

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. DANIEL NAYSAN
Credential	:	DDS
Telephone Number	:	310-278-0600

Provider Enumeration Date	:	12/29/2014
Last Update Date	:	12/29/2014

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