MEDICARE: ANN MARIE GORCZYCA D.M.D., M.P.H., M.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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	40756	CA
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry		CA

General Provider Information

NPI Number	:	1649351255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN MARIE GORCZYCA D.M.D., M.P.H., M.S.

Provider Business Mailing Address
First Line	:	5201 DEER VALLEY RD
Second Line	:	SUITE 1-A
City	:	ANTIOCH
State	:	CA
Zip	:	94531-7429
Country	:	US
Telephone Number	:	925-757-9000
Fax Number	:	925-757-9651

Provider Business Practice Location Address
First Line	:	5201 DEER VALLEY RD
Second Line	:	SUITE 1-A
City	:	ANTIOCH
State	:	CA
Zip	:	94531-7429
Country	:	US
Telephone Number	:	925-757-9000
Fax Number	:	925-757-9651

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/08/2007

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