MEDICARE: FLOYD J CAWTHON III 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	32043	CA

General Provider Information

NPI Number	:	1538330386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FLOYD J CAWTHON III DDS

Provider Business Mailing Address
First Line	:	4924 BALBOA BLVD # 223
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91316-3402
Country	:	US
Telephone Number	:	805-479-8706
Fax Number	:

Provider Business Practice Location Address
First Line	:	4924 BALBOA BLVD # 223
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91316-3402
Country	:	US
Telephone Number	:	805-479-8706
Fax Number	:

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

Provider Enumeration Date	:	03/20/2008
Last Update Date	:	03/20/2008

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