MEDICARE: DR. BRADFORD J. STAPH 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	30414	CA

General Provider Information

NPI Number	:	1780891630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRADFORD J. STAPH DDS

Provider Business Mailing Address
First Line	:	30210 RANCHO VIEJO RD
Second Line	:	SUITE B
City	:	SAN JUAN CAPISTRANO
State	:	CA
Zip	:	92675-1574
Country	:	US
Telephone Number	:	949-493-8118
Fax Number	:

Provider Business Practice Location Address
First Line	:	30210 RANCHO VIEJO RD
Second Line	:	SUITE B
City	:	SAN JUAN CAPISTRANO
State	:	CA
Zip	:	92675-1574
Country	:	US
Telephone Number	:	949-493-8118
Fax Number	:

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

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/08/2007

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