MEDICARE: DR. LUZVIMINDA V DAYRIT 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	51385	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51385	OTHER	CA	DENTIST

General Provider Information

NPI Number	:	1699822767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUZVIMINDA V DAYRIT DDS

Provider Business Mailing Address
First Line	:	6937 COLUMBIA CT
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91739-2057
Country	:	US
Telephone Number	:	909-646-9482
Fax Number	:

Provider Business Practice Location Address
First Line	:	6937 COLUMBIA CT
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91739-2057
Country	:	US
Telephone Number	:	909-646-9482
Fax Number	:

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

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	11/23/2020

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