MEDICARE: DR. REYNALDO PESTANO BARBON JR. 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	1223G0001X	General Practice Dentistry	51320	CA

General Provider Information

NPI Number	:	1962570325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REYNALDO PESTANO BARBON JR. DDS

Provider Business Mailing Address
First Line	:	1912 NOLDEN ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90041-3113
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3317 BROOKHILL ST
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91214-1233
Country	:	US
Telephone Number	:	323-215-6352
Fax Number	:

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

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	12/05/2007

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