MEDICARE: BIJAN AFLATOONI DMD

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	51206	CA

General Provider Information

NPI Number	:	1518053107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BIJAN AFLATOONI DMD

Provider Business Mailing Address
First Line	:	9381 E STOCKTON BLVD STE 219
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95624-5070
Country	:	US
Telephone Number	:	916-670-1886
Fax Number	:

Provider Business Practice Location Address
First Line	:	9381 E STOCKTON BLVD STE 219
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95624-5070
Country	:	US
Telephone Number	:	916-670-1886
Fax Number	:

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	02/11/2010

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