MEDICARE: LOTFI DDS, INC.

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	54282	CA

General Provider Information

NPI Number	:	1972764959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOTFI DDS, INC.

Provider Business Mailing Address
First Line	:	732 SYLVAN WAY
Second Line	:
City	:	EMERALD HILLS
State	:	CA
Zip	:	94062-3900
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4533 STEVENS CREEK BLVD
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95051-6856
Country	:	US
Telephone Number	:	408-345-9191
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MEHRNEGAR LOTFI
Credential	:
Telephone Number	:	650-455-4570

Provider Enumeration Date	:	06/23/2008
Last Update Date	:	06/23/2008

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