MEDICARE: DANKWORTH DDS AND CORRIGAN-DANKWORTH DDS, INC

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	032819	CA
2	122300000X	Dentist	DB033273	CA

General Provider Information

NPI Number	:	1750399648
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANKWORTH DDS AND CORRIGAN-DANKWORTH DDS, INC

Provider Business Mailing Address
First Line	:	7730 RANCHO SANTA FE ROAD
Second Line	:	SUITE 106
City	:	CARLSBAD
State	:	CA
Zip	:	92009
Country	:	US
Telephone Number	:	760-633-3033
Fax Number	:	760-633-3990

Provider Business Practice Location Address
First Line	:	7730 RANCHO SANTA FE ROAD
Second Line	:	SUITE 106
City	:	CARLSBAD
State	:	CA
Zip	:	92009
Country	:	US
Telephone Number	:	760-633-3033
Fax Number	:	760-633-3990

Authorized Official
Title or Position	:	PRESIDENT OWNER
Name	:	DR. STEPHEN R DANKWORTH
Credential	:	DDS
Telephone Number	:	760-633-3033

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	06/18/2008

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