MEDICARE: NARINE DANIELIAN 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	261QD0000X	Dental Clinic/Center	49867	CA

General Provider Information

NPI Number	:	1215123591
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NARINE DANIELIAN DDS, INC.

Provider Business Mailing Address
First Line	:	4406 W MAGNOLIA BLVD STE A
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-2729
Country	:	US
Telephone Number	:	818-260-0274
Fax Number	:	818-260-8743

Provider Business Practice Location Address
First Line	:	4406 W MAGNOLIA BLVD STE A
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-2729
Country	:	US
Telephone Number	:	818-260-0274
Fax Number	:	818-260-8743

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. NARINE DANIELIAN
Credential	:	DDS
Telephone Number	:	818-260-0274

Provider Enumeration Date	:	09/19/2007
Last Update Date	:	09/19/2007

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