MEDICARE: DR. ROGER HENRY TUBBESING 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	19393	CA

General Provider Information

NPI Number	:	1861656274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER HENRY TUBBESING DDS

Provider Business Mailing Address
First Line	:	233 A ST
Second Line	:	SUITE 701
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-4007
Country	:	US
Telephone Number	:	619-232-3774
Fax Number	:	619-232-5214

Provider Business Practice Location Address
First Line	:	233 A ST
Second Line	:	SUITE 701
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-4007
Country	:	US
Telephone Number	:	619-232-3774
Fax Number	:	619-232-5214

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

Provider Enumeration Date	:	07/15/2008
Last Update Date	:	07/15/2008

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