MEDICARE: DR. ELAINE TAMIKO 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	1223P0700X	Prosthodontics	46332	CA

General Provider Information

NPI Number	:	1235288432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELAINE TAMIKO D.D.S.

Provider Business Mailing Address
First Line	:	2247 W BALL RD
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92804-5314
Country	:	US
Telephone Number	:	714-778-4767
Fax Number	:

Provider Business Practice Location Address
First Line	:	2247 W BALL RD
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92804-5314
Country	:	US
Telephone Number	:	714-778-4767
Fax Number	:

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	06/28/2010

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