MEDICARE: DR. VACHAREE B FELL DDS, MS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	27410	CA

General Provider Information

NPI Number	:	1710013487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VACHAREE B FELL DDS, MS

Provider Business Mailing Address
First Line	:	10811 WASHINGTON BLVD STE 200
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90232-3624
Country	:	US
Telephone Number	:	310-837-5900
Fax Number	:

Provider Business Practice Location Address
First Line	:	10811 WASHINGTON BLVD STE 200
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90232-3624
Country	:	US
Telephone Number	:	310-837-5900
Fax Number	:

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	07/08/2007

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