MEDICARE: DR. E.G. RIGHELLIS DDS

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	22279	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22279	OTHER	CA	CALIFORNIA LICENSE NUMBER

General Provider Information

NPI Number	:	1841344330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. E.G. RIGHELLIS DDS

Provider Business Mailing Address
First Line	:	2220 MOUNTAIN BLVD
Second Line	:	SUITE 204
City	:	OAKLAND
State	:	CA
Zip	:	94611-2905
Country	:	US
Telephone Number	:	510-482-0600
Fax Number	:	510-482-4710

Provider Business Practice Location Address
First Line	:	2220 MOUNTAIN BLVD
Second Line	:	SUITE 204
City	:	OAKLAND
State	:	CA
Zip	:	94611-2905
Country	:	US
Telephone Number	:	510-482-0600
Fax Number	:	510-482-4710

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	07/08/2007

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