MEDICARE: DR. JANELLE HOLDEN D.D.S.

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	1223P0221X	Pediatric Dentistry	41617	CA

General Provider Information

NPI Number	:	1619038825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANELLE HOLDEN D.D.S.

Provider Business Mailing Address
First Line	:	451 MANHATTAN BEACH BLVD
Second Line	:	SUITE D226
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-5345
Country	:	US
Telephone Number	:	310-545-5757
Fax Number	:	310-545-2929

Provider Business Practice Location Address
First Line	:	451 MANHATTAN BEACH BLVD
Second Line	:	SUITE D226
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-5345
Country	:	US
Telephone Number	:	310-545-5757
Fax Number	:	310-545-2929

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

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	07/08/2007

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