MEDICARE: DR. BRIAN H SASADA 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	1223G0001X	General Practice Dentistry	28484	CA

General Provider Information

NPI Number	:	1669519666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN H SASADA DDS

Provider Business Mailing Address
First Line	:	305 E HARVARD BLVD
Second Line	:
City	:	SANTA PAULA
State	:	CA
Zip	:	93060-3316
Country	:	US
Telephone Number	:	805-525-1573
Fax Number	:	805-525-1573

Provider Business Practice Location Address
First Line	:	305 E HARVARD BLVD
Second Line	:
City	:	SANTA PAULA
State	:	CA
Zip	:	93060-3316
Country	:	US
Telephone Number	:	805-525-1573
Fax Number	:	805-525-1573

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	07/08/2007

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