MEDICARE: DR. ROCHELI BULANADI NOBLE-DURIAN 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	49381	CA

General Provider Information

NPI Number	:	1376750067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROCHELI BULANADI NOBLE-DURIAN D.D.S.

Provider Business Mailing Address
First Line	:	18800 AMAR RD
Second Line	:	SUITE #C4
City	:	WALNUT
State	:	CA
Zip	:	91789-4166
Country	:	US
Telephone Number	:	626-581-0069
Fax Number	:	626-581-0070

Provider Business Practice Location Address
First Line	:	18800 AMAR RD
Second Line	:	SUITE #C4
City	:	WALNUT
State	:	CA
Zip	:	91789-4166
Country	:	US
Telephone Number	:	626-581-0069
Fax Number	:	626-581-0070

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

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	07/08/2007

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