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NPI Code Detail

MEDICARE: DR. LARA MESROB YEGHIASARIAN D.M.D.

MEDICARE: DR. LARA MESROB YEGHIASARIAN D.M.D.
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
1122300000XDentist9528CO
21223E0200XEndodonticsDS044849PA

General Provider Information

NPI Number : 1316130123
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LARA MESROB YEGHIASARIAN D.M.D.
Provider Business Mailing Address
First Line : 7010 MORRISON AVE BLDG 128
Second Line : DENTAL ACTIVITY
City : FORT BENNING
State : GA
Zip : 31905-0102
Country : US
Telephone Number : 706-544-4530
Fax Number :
Provider Business Practice Location Address
First Line : 7010 MORRISON AVE BLDG 128
Second Line : DENTAL ACTIVITY
City : FORT BENNING
State : GA
Zip : 31905-0102
Country : US
Telephone Number : 706-544-4530
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2007
Last Update Date : 10/02/2024

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