MEDICARE: CHAD BURGESS

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	1223E0200X	Endodontics	48788	CA

General Provider Information

NPI Number	:	1821173022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHAD BURGESS

Provider Business Mailing Address
First Line	:	780 SETTLERS CT
Second Line	:
City	:	SAN MARCOS
State	:	CA
Zip	:	92069-1961
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3601 VISTA WAY
Second Line	:	SUITE 202
City	:	OCEANSIDE
State	:	CA
Zip	:	92056-4559
Country	:	US
Telephone Number	:	760-216-3600
Fax Number	:

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

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	04/25/2011

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Directions to “ CHAD BURGESS ” Practice Location

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