MEDICARE: MARTIN H MARDIROSIAN D.D.S, M.S.

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	61160	CA

General Provider Information

NPI Number	:	1043566284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTIN H MARDIROSIAN D.D.S, M.S.

Provider Business Mailing Address
First Line	:	20047 CHAPTER DR
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-5669
Country	:	US
Telephone Number	:	818-396-6278
Fax Number	:

Provider Business Practice Location Address
First Line	:	20047 CHAPTER DR
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-5669
Country	:	US
Telephone Number	:	818-396-6278
Fax Number	:

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

Provider Enumeration Date	:	07/25/2012
Last Update Date	:	07/25/2012

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