MEDICARE: DR. AUDREY A. FOROUTAN 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	49315	CA

General Provider Information

NPI Number	:	1093772139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AUDREY A. FOROUTAN D.M.D.

Provider Business Mailing Address
First Line	:	700 GARDEN VIEW CT
Second Line	:	SUITE 200
City	:	ENCINITAS
State	:	CA
Zip	:	92024-2464
Country	:	US
Telephone Number	:	760-944-5588
Fax Number	:	760-944-5688

Provider Business Practice Location Address
First Line	:	700 GARDEN VIEW CT
Second Line	:	SUITE 200
City	:	ENCINITAS
State	:	CA
Zip	:	92024-2464
Country	:	US
Telephone Number	:	760-944-5588
Fax Number	:	760-944-5688

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

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	11/04/2008

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