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NPI Code Detail

MEDICARE: OLIVER M VENGCO DMD

MEDICARE: OLIVER M VENGCO DMD
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
1122300000XDentist45211CA

General Provider Information

NPI Number : 1811192982
Entity Type Code : Individual
Provider Name (Legal Business Name) : OLIVER M VENGCO DMD
Provider Business Mailing Address
First Line : 2055 GELLERT BLVD STE 4
Second Line :
City : DALY CITY
State : CA
Zip : 94015-2814
Country : US
Telephone Number : 650-754-1300
Fax Number : 650-754-1122
Provider Business Practice Location Address
First Line : 2055 GELLERT BLVD STE 4
Second Line :
City : DALY CITY
State : CA
Zip : 94015-2814
Country : US
Telephone Number : 650-754-1300
Fax Number : 650-754-1122
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2007
Last Update Date : 07/08/2007

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