MEDICARE: DR. JANICE S PRONSTROLLER 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	49642	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	49642	OTHER	CA	STATE LICENSE NO.

General Provider Information

NPI Number	:	1669538724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANICE S PRONSTROLLER D.D.S.

Provider Business Mailing Address
First Line	:	460 LONG BEACH BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-2436
Country	:	US
Telephone Number	:	562-436-9234
Fax Number	:	562-436-9233

Provider Business Practice Location Address
First Line	:	460 LONG BEACH BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-2436
Country	:	US
Telephone Number	:	562-436-9234
Fax Number	:	562-436-9233

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

Provider Enumeration Date	:	12/30/2006
Last Update Date	:	05/06/2015

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Directions to “ DR. JANICE S PRONSTROLLER D.D.S.” Practice Location

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