MEDICARE: DR. JOSE G PEDROZA 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	122300000X	Dentist	19024714	IL
2	1223P0700X	Prosthodontics	51534	CA

General Provider Information

NPI Number	:	1881642593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE G PEDROZA DDS

Provider Business Mailing Address
First Line	:	1218 LAKE POINT DR
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-7481
Country	:	US
Telephone Number	:	904-434-3035
Fax Number	:

Provider Business Practice Location Address
First Line	:	1218 LAKE POINT DR
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-7481
Country	:	US
Telephone Number	:	904-434-3035
Fax Number	:

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	09/12/2011

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