MEDICARE: DR. HOURI FATOURACHI 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	1223P0221X	Pediatric Dentistry	47887	CA

General Provider Information

NPI Number	:	1346462231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOURI FATOURACHI DDS

Provider Business Mailing Address
First Line	:	2325 SOUTH MELROSE DRIVE
Second Line	:
City	:	VISTA
State	:	CA
Zip	:	92081
Country	:	US
Telephone Number	:	760-734-4400
Fax Number	:	760-734-4454

Provider Business Practice Location Address
First Line	:	2325 SOUTH MELROSE DRIVE
Second Line	:
City	:	VISTA
State	:	CA
Zip	:	92081
Country	:	US
Telephone Number	:	760-734-4400
Fax Number	:	760-734-4454

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

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	04/09/2009

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