MEDICARE: DR. MARIANNE C DEMIRDJI DDS, MS

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	100674	CA

General Provider Information

NPI Number	:	1093359788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIANNE C DEMIRDJI DDS, MS

Provider Business Mailing Address
First Line	:	320 ARDEN AVE STE 200
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91203-1173
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 ARDEN AVE STE 200
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91203-1173
Country	:	US
Telephone Number	:	818-242-3377
Fax Number	:

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

Provider Enumeration Date	:	11/05/2019
Last Update Date	:	11/05/2021

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