MEDICARE: M HIROTA DMD A 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	122300000X	Dentist	35117	CA

General Provider Information

NPI Number	:	1548509862
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M HIROTA DMD A DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	135 CIVIC CENTER DR
Second Line	:	102
City	:	NATIONAL CITY
State	:	CA
Zip	:	91950-4357
Country	:	US
Telephone Number	:	619-474-4695
Fax Number	:	619-252-4935

Provider Business Practice Location Address
First Line	:	135 CIVIC CENTER DR
Second Line	:	102
City	:	NATIONAL CITY
State	:	CA
Zip	:	91950-4357
Country	:	US
Telephone Number	:	619-474-4695
Fax Number	:	619-252-4935

Authorized Official
Title or Position	:	CEO
Name	:	MISAKO HIROTA
Credential	:	D.M.D.
Telephone Number	:	619-474-4695

Provider Enumeration Date	:	02/06/2013
Last Update Date	:	02/06/2013

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