MEDICARE: DR. MOHAMMAD BAGHER JAFARI D.M.D.

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	39283	CA

General Provider Information

NPI Number	:	1891967220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMMAD BAGHER JAFARI D.M.D.

Provider Business Mailing Address
First Line	:	12840 RIVERSIDE DR
Second Line	:	SUITE # 400
City	:	STUDIO CITY
State	:	CA
Zip	:	91607-3327
Country	:	US
Telephone Number	:	818-762-6060
Fax Number	:	818-762-1765

Provider Business Practice Location Address
First Line	:	12840 RIVERSIDE DR
Second Line	:	SUITE # 400
City	:	STUDIO CITY
State	:	CA
Zip	:	91607-3327
Country	:	US
Telephone Number	:	818-762-6060
Fax Number	:	818-762-1765

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

Provider Enumeration Date	:	03/26/2008
Last Update Date	:	03/26/2008

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