MEDICARE: ROBERT I HLAVAC, 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	39009	CA

General Provider Information

NPI Number	:	1578721692
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT I HLAVAC, DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	2917 SALVIO ST
Second Line	:	SUITE B
City	:	CONCORD
State	:	CA
Zip	:	94519-2580
Country	:	US
Telephone Number	:	925-689-1772
Fax Number	:	925-689-3222

Provider Business Practice Location Address
First Line	:	2917 SALVIO ST
Second Line	:	SUITE B
City	:	CONCORD
State	:	CA
Zip	:	94519-2580
Country	:	US
Telephone Number	:	925-689-1772
Fax Number	:	925-689-3222

Authorized Official
Title or Position	:	CEO / DENTIST
Name	:	DR. ROBERT I HLAVAC
Credential	:	D.D.S.
Telephone Number	:	925-689-1772

Provider Enumeration Date	:	05/27/2008
Last Update Date	:	05/27/2008

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