MEDICARE: DR. RAFFI BAGDASSARIAN 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	1223G0001X	General Practice Dentistry	19338	MA

General Provider Information

NPI Number	:	1598838534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAFFI BAGDASSARIAN DMD

Provider Business Mailing Address
First Line	:	250 TRAPELO RD
Second Line	:
City	:	BELMONT
State	:	MA
Zip	:	02478-1849
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 TRAPELO RD
Second Line	:
City	:	BELMONT
State	:	MA
Zip	:	02478-1849
Country	:	US
Telephone Number	:	617-489-1900
Fax Number	:

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

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	07/08/2007

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