MEDICARE: DENTAL SERVICES, 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	122300000X	Dentist

General Provider Information

NPI Number	:	1659647469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL SERVICES, D.D.S.

Provider Business Mailing Address
First Line	:	2892 N BELLFLOWER BLVD
Second Line	:	SUITE 281
City	:	LONG BEACH
State	:	CA
Zip	:	90815-1125
Country	:	US
Telephone Number	:	888-417-5163
Fax Number	:

Provider Business Practice Location Address
First Line	:	2892 N BELLFLOWER BLVD
Second Line	:	SUITE 281
City	:	LONG BEACH
State	:	CA
Zip	:	90815-1125
Country	:	US
Telephone Number	:	888-417-5163
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	ELVIS BAQUEROS
Credential	:	D.D.S.
Telephone Number	:	888-417-5163

Provider Enumeration Date	:	03/26/2012
Last Update Date	:	03/26/2012

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