MEDICARE: DR. JOSE LUIS CARDENAS 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	54130	CA

General Provider Information

NPI Number	:	1962619403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE LUIS CARDENAS DDS

Provider Business Mailing Address
First Line	:	37 ARNOLD WAY
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92602-0748
Country	:	US
Telephone Number	:	714-731-5026
Fax Number	:	714-667-0360

Provider Business Practice Location Address
First Line	:	1701 N MAIN ST
Second Line	:	SUIT 100
City	:	SANTA ANA
State	:	CA
Zip	:	92706-2745
Country	:	US
Telephone Number	:	714-667-0367
Fax Number	:	714-667-0360

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

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	07/08/2007

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