MEDICARE: DR. SHANNON H. LAZARIAN 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	1223G0001X	General Practice Dentistry	58611	CA
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1043451735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANNON H. LAZARIAN DDS

Provider Business Mailing Address
First Line	:	14445 OLIVE VIEW DR
Second Line	:
City	:	SYLMAR
State	:	CA
Zip	:	91342-1437
Country	:	US
Telephone Number	:	818-364-4350
Fax Number	:

Provider Business Practice Location Address
First Line	:	6269 CHARONOAK PL
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91775
Country	:	US
Telephone Number	:	266-318-2928
Fax Number	:

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

Provider Enumeration Date	:	03/10/2009
Last Update Date	:	07/03/2018

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