MEDICARE: DR. NELSON REED GATOV 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	24925	CA

General Provider Information

NPI Number	:	1720177546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NELSON REED GATOV D.D.S.

Provider Business Mailing Address
First Line	:	6330 E SPRING ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-1424
Country	:	US
Telephone Number	:	562-421-9439
Fax Number	:	562-421-9430

Provider Business Practice Location Address
First Line	:	6330 E SPRING ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-1424
Country	:	US
Telephone Number	:	562-421-9439
Fax Number	:	562-421-9430

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/08/2007

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