MEDICARE: JOG DENTAL CORPORATION

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	44707	CA

General Provider Information

NPI Number	:	1538378575
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOG DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	2975 BOWERS AVE
Second Line	:	SUITE 100
City	:	SANTA CLARA
State	:	CA
Zip	:	95051-0955
Country	:	US
Telephone Number	:	408-987-0530
Fax Number	:	408-986-1337

Provider Business Practice Location Address
First Line	:	2975 BOWERS AVE
Second Line	:	SUITE 100
City	:	SANTA CLARA
State	:	CA
Zip	:	95051-0955
Country	:	US
Telephone Number	:	408-987-0530
Fax Number	:	408-986-1337

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANAGHA B JOG
Credential	:	DMD
Telephone Number	:	408-987-0530

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	12/23/2008

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Directions to “JOG DENTAL CORPORATION ” Practice Location

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