MEDICARE: DR. ALLAN JOSEPH DOVIGI DDS

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	1223P0106X	Oral and Maxillofacial Pathology Dentistry	7084	AZ
2	1223P0106X	Oral and Maxillofacial Pathology Dentistry	60085	CA

General Provider Information

NPI Number	:	1629168265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLAN JOSEPH DOVIGI DDS

Provider Business Mailing Address
First Line	:	9520 CHESAPEAKE DR
Second Line	:	SUITE 607
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1331
Country	:	US
Telephone Number	:	800-955-4765
Fax Number	:

Provider Business Practice Location Address
First Line	:	9520 CHESAPEAKE DR
Second Line	:	SUITE 607
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1331
Country	:	US
Telephone Number	:	800-955-4765
Fax Number	:

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	01/25/2016

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