MEDICARE: PRAFULLA JOSHI D.D.S

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	34126	CA

General Provider Information

NPI Number	:	1003868068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRAFULLA JOSHI D.D.S

Provider Business Mailing Address
First Line	:	3860 CRENSHAW BLVD
Second Line	:	#229
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-1816
Country	:	US
Telephone Number	:	323-296-2019
Fax Number	:

Provider Business Practice Location Address
First Line	:	3860 CRENSHAW BLVD
Second Line	:	#229
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-1816
Country	:	US
Telephone Number	:	323-296-2019
Fax Number	:

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	07/14/2015

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