MEDICARE: DR. RALPH PETER VANDERSLOOT 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	1223P0300X	Periodontics	CDL 22301	CA

General Provider Information

NPI Number	:	1952304602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RALPH PETER VANDERSLOOT DDS, MS

Provider Business Mailing Address
First Line	:	5700 STONERIDGE MALL RD
Second Line	:	STE 290
City	:	PLEASANTON
State	:	CA
Zip	:	94588-2847
Country	:	US
Telephone Number	:	925-463-1450
Fax Number	:	925-463-0838

Provider Business Practice Location Address
First Line	:	5700 STONERIDGE MALL RD
Second Line	:	STE 290
City	:	PLEASANTON
State	:	CA
Zip	:	94588-2847
Country	:	US
Telephone Number	:	925-463-1450
Fax Number	:	925-463-0838

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/08/2007

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