MEDICARE: REZA FOULADI D.D.S, M.D.

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	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	A126291	CA
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	55172	CA

General Provider Information

NPI Number	:	1962561340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REZA FOULADI D.D.S, M.D.

Provider Business Mailing Address
First Line	:	7551 TIMBERLAKE WAY STE 120
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-5421
Country	:	US
Telephone Number	:	949-727-7000
Fax Number	:	949-727-3924

Provider Business Practice Location Address
First Line	:	7551 TIMBERLAKE WAY STE 120
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-5421
Country	:	US
Telephone Number	:	949-727-7000
Fax Number	:	949-727-3924

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

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	05/21/2020

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