MEDICARE: RAFFI GUEDIKIAN DDS INC

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	37424	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G9359101	OTHER	CA	DENTI-CAL

General Provider Information

NPI Number	:	1548456130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAFFI GUEDIKIAN DDS INC

Provider Business Mailing Address
First Line	:	3116 PECK RD
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91731-3428
Country	:	US
Telephone Number	:	626-454-2444
Fax Number	:	626-454-1515

Provider Business Practice Location Address
First Line	:	3116 PECK RD
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91731-3428
Country	:	US
Telephone Number	:	626-454-2444
Fax Number	:	626-454-1515

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. RAFFI ALBERT GUEDIKIAN
Credential	:	DDS
Telephone Number	:	626-454-2444

Provider Enumeration Date	:	09/18/2007
Last Update Date	:	04/02/2008

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