MEDICARE: DON C ATKINS III

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	27227	CA

General Provider Information

NPI Number	:	1639550361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DON C ATKINS III

Provider Business Mailing Address
First Line	:	4440 E VILLAGE RD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-1540
Country	:	US
Telephone Number	:	562-425-3311
Fax Number	:

Provider Business Practice Location Address
First Line	:	4440 E VILLAGE RD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-1540
Country	:	US
Telephone Number	:	562-425-3311
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DON C ATKINS
Credential	:	DDS
Telephone Number	:	562-425-3311

Provider Enumeration Date	:	06/18/2015
Last Update Date	:	07/13/2015

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