MEDICARE: DR. ROBERT EDWARD CLAMAN 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	1223G0001X	General Practice Dentistry	19043	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	61866444	OTHER		TPIN-CCR US GOVT
2	116835430	OTHER		DUN & BRADSTREET

General Provider Information

NPI Number	:	1801819669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT EDWARD CLAMAN D.D.S.

Provider Business Mailing Address
First Line	:	PO BOX 1859
Second Line	:	925 N. LAKE BLVD., SUITE B-206
City	:	TAHOE CITY
State	:	CA
Zip	:	96145-1859
Country	:	US
Telephone Number	:	530-583-4276
Fax Number	:	530-583-6637

Provider Business Practice Location Address
First Line	:	925 NORTH LAKE BLVD
Second Line	:	SUITE B-206
City	:	TAHOE CITY
State	:	CA
Zip	:	96145-1859
Country	:	US
Telephone Number	:	530-583-4276
Fax Number	:	530-583-6637

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	05/15/2012

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