MEDICARE: DR. RAMI ALFROUKH B.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	122300000X	Dentist	101072	CA

General Provider Information

NPI Number	:	1235571753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAMI ALFROUKH B.D.S.

Provider Business Mailing Address
First Line	:	2309 E BRANDYWINE LN
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93720-4661
Country	:	US
Telephone Number	:	267-242-0022
Fax Number	:

Provider Business Practice Location Address
First Line	:	2309 E BRANDYWINE LN
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93720-3905
Country	:	US
Telephone Number	:	267-242-0022
Fax Number	:

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

Provider Enumeration Date	:	07/25/2013
Last Update Date	:	12/12/2016

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