MEDICARE: DR. KEVIN J CEBULA D.D.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	1223X2210X	Orofacial Pain Dentistry	64314	CA

General Provider Information

NPI Number	:	1962464040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN J CEBULA D.D.S.

Provider Business Mailing Address
First Line	:	301 S FAIR OAKS AVE
Second Line	:	STE 402
City	:	PASADENA
State	:	CA
Zip	:	91105-2562
Country	:	US
Telephone Number	:	626-658-9004
Fax Number	:	626-658-9034

Provider Business Practice Location Address
First Line	:	301 S FAIR OAKS AVE
Second Line	:	STE 402
City	:	PASADENA
State	:	CA
Zip	:	91105-2562
Country	:	US
Telephone Number	:	626-658-9004
Fax Number	:	626-658-9034

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

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	02/13/2020

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