MEDICARE: MR. VIMAL AMRAL DULABH DDS

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	122300000X	Dentist	48101	CA

General Provider Information

NPI Number	:	1235245168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VIMAL AMRAL DULABH DDS

Provider Business Mailing Address
First Line	:	3535 ELVERTA RD
Second Line	:	SUITE E
City	:	ANTELOPE
State	:	CA
Zip	:	95843
Country	:	US
Telephone Number	:	916-349-9990
Fax Number	:	916-349-9991

Provider Business Practice Location Address
First Line	:	3535 ELVERTA RD
Second Line	:	SUITE E
City	:	ANTELOPE
State	:	CA
Zip	:	95843
Country	:	US
Telephone Number	:	916-349-9990
Fax Number	:	916-349-9991

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

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	07/08/2007

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