MEDICARE: DR. JOHN C PAWLAK D.D.S., M.S.

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	33969	CA

General Provider Information

NPI Number	:	1942348560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN C PAWLAK D.D.S., M.S.

Provider Business Mailing Address
First Line	:	7900 EL CAJON BLVD STE F
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91941-3655
Country	:	US
Telephone Number	:	619-465-1733
Fax Number	:	619-465-0179

Provider Business Practice Location Address
First Line	:	7900 EL CAJON BLVD STE F
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91941-3655
Country	:	US
Telephone Number	:	619-465-1733
Fax Number	:	619-465-0179

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

Provider Enumeration Date	:	02/03/2007
Last Update Date	:	07/08/2007

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