MEDICARE: FELINES HORNILLA TIPTON 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	43685	CA

General Provider Information

NPI Number	:	1336273309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FELINES HORNILLA TIPTON D.D.S.

Provider Business Mailing Address
First Line	:	PO BOX 6160
Second Line	:
City	:	EUREKA
State	:	CA
Zip	:	95502-6160
Country	:	US
Telephone Number	:	707-443-7043
Fax Number	:	707-443-1375

Provider Business Practice Location Address
First Line	:	805 HARRIS ST
Second Line	:
City	:	EUREKA
State	:	CA
Zip	:	95503-4541
Country	:	US
Telephone Number	:	707-443-7043
Fax Number	:	707-443-1375

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/08/2007

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