MEDICARE: FATIMA VAFAI 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	261QD0000X	Dental Clinic/Center	54429	CA

General Provider Information

NPI Number	:	1558687483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FATIMA VAFAI DDS, INC

Provider Business Mailing Address
First Line	:	4748 RASPBERRY PL
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95129-1935
Country	:	US
Telephone Number	:	408-569-1251
Fax Number	:

Provider Business Practice Location Address
First Line	:	888 SARATOGA AVE STE 102
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95129-2639
Country	:	US
Telephone Number	:	408-569-1251
Fax Number	:

Authorized Official
Title or Position	:	DENTIST/CEO
Name	:	FATIMA VAFAI
Credential	:	DDS
Telephone Number	:	408-569-1251

Provider Enumeration Date	:	04/16/2010
Last Update Date	:	04/16/2010

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