MEDICARE: DR. CRAIG S GAINZA D.D.S., M.S.D.

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	1223P0300X	Periodontics	31464	CA

General Provider Information

NPI Number	:	1922194026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG S GAINZA D.D.S., M.S.D.

Provider Business Mailing Address
First Line	:	27 ROTARY WAY
Second Line	:
City	:	VALLEJO
State	:	CA
Zip	:	94591-8475
Country	:	US
Telephone Number	:	707-642-4119
Fax Number	:	707-642-7833

Provider Business Practice Location Address
First Line	:	27 ROTARY WAY
Second Line	:
City	:	VALLEJO
State	:	CA
Zip	:	94591-8475
Country	:	US
Telephone Number	:	707-642-4119
Fax Number	:	707-642-7833

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	07/08/2007

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