MEDICARE: DR. MCLAUGHLIN & DR. UPATHAM

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	21482	CA

General Provider Information

NPI Number	:	1588844922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. MCLAUGHLIN & DR. UPATHAM

Provider Business Mailing Address
First Line	:	1831 SUNSET CLIFFS BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92107-3108
Country	:	US
Telephone Number	:	619-225-1611
Fax Number	:

Provider Business Practice Location Address
First Line	:	1831 SUNSET CLIFFS BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92107-3108
Country	:	US
Telephone Number	:	619-225-1611
Fax Number	:

Authorized Official
Title or Position	:	ADMIN
Name	:	MS. AMANDA HARRIS
Credential	:
Telephone Number	:	619-225-1611

Provider Enumeration Date	:	11/13/2007
Last Update Date	:	11/13/2007

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