MEDICARE: DR. TALIA AMIR, A DENTAL PROFESSIONAL CORPORATION

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	47033	CA

General Provider Information

NPI Number	:	1467634394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. TALIA AMIR, A DENTAL PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	6007 LANKERSHIM BLVD STE 9
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-4883
Country	:	US
Telephone Number	:	818-506-2977
Fax Number	:	818-506-4610

Provider Business Practice Location Address
First Line	:	6007 LANKERSHIM BLVD #9
Second Line	:
City	:	NORTH HOLLWODD
State	:	CA
Zip	:	91606
Country	:	US
Telephone Number	:	818-506-2977
Fax Number	:	818-506-4610

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TALIA AMIR
Credential	:	DDS
Telephone Number	:	818-506-2977

Provider Enumeration Date	:	12/03/2007
Last Update Date	:	12/03/2007

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