MEDICARE: KARMELL RAFISOLYMAN DDS INC

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	47997	CA

General Provider Information

NPI Number	:	1407073778
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KARMELL RAFISOLYMAN DDS INC

Provider Business Mailing Address
First Line	:	2841 TULARE ST
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93721-1320
Country	:	US
Telephone Number	:	559-256-2150
Fax Number	:	559-435-3698

Provider Business Practice Location Address
First Line	:	2841 TULARE ST
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93721-1320
Country	:	US
Telephone Number	:	559-256-2150
Fax Number	:	559-435-3698

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KARMELL RAFISOLYMAN
Credential	:	D.D.S.
Telephone Number	:	559-256-2150

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	08/22/2020

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