MEDICARE: DR. TOURAN DAVOUDI 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	1223G0001X	General Practice Dentistry	47873	CA

General Provider Information

NPI Number	:	1114148079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TOURAN DAVOUDI D.D.S

Provider Business Mailing Address
First Line	:	5450 CLAIREMONT MESA BLVD
Second Line	:	SUITE C
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-2346
Country	:	US
Telephone Number	:	858-503-6789
Fax Number	:	858-503-6790

Provider Business Practice Location Address
First Line	:	5450 CLAIREMONT MESA BLVD
Second Line	:	SUITE C
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-2346
Country	:	US
Telephone Number	:	858-503-6789
Fax Number	:	858-503-6790

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

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	07/08/2007

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