MEDICARE: DR. FRANK JOSEPH MOGAVERO DDS MS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	36265	CA

General Provider Information

NPI Number	:	1841300910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRANK JOSEPH MOGAVERO DDS MS

Provider Business Mailing Address
First Line	:	1031 AVENIDA PICO
Second Line	:	SUITE 101
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92673-6352
Country	:	US
Telephone Number	:	949-373-3737
Fax Number	:	949-373-3779

Provider Business Practice Location Address
First Line	:	1031 AVENIDA PICO
Second Line	:	SUITE 101
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92673-6352
Country	:	US
Telephone Number	:	949-373-3737
Fax Number	:	949-373-3779

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	02/12/2009

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