MEDICARE: ASMIK MADOULIAN 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	45287	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1881781201	OTHER	CA	NPI

General Provider Information

NPI Number	:	1689023467
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASMIK MADOULIAN DDS INC

Provider Business Mailing Address
First Line	:	10903 MAGNOLIA BLVD
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91601-3904
Country	:	US
Telephone Number	:	818-762-9112
Fax Number	:	818-762-4974

Provider Business Practice Location Address
First Line	:	10903 MAGNOLIA BLVD
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91601-3904
Country	:	US
Telephone Number	:	818-762-9112
Fax Number	:	818-762-4974

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. ASMIK ANDRANIK MADOULIAN
Credential	:	DDS
Telephone Number	:	818-762-9112

Provider Enumeration Date	:	06/13/2016
Last Update Date	:	06/13/2016

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