MEDICARE: DR. AHMAD FAHID DDS MS

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	1223E0200X	Endodontics	31253	CA

General Provider Information

NPI Number	:	1770885378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AHMAD FAHID DDS MS

Provider Business Mailing Address
First Line	:	436 N BEDFORD DR 208
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	436 N BEDFORD DR STE 208
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-4312
Country	:	US
Telephone Number	:	310-274-4411
Fax Number	:

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

Provider Enumeration Date	:	12/02/2010
Last Update Date	:	12/02/2010

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