MEDICARE: JOSEPH R. MICHERI 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	1223G0001X	General Practice Dentistry	36583	CA

General Provider Information

NPI Number	:	1750690954
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSEPH R. MICHERI DDS INC

Provider Business Mailing Address
First Line	:	2815 W. SUNSET BLVD.
Second Line	:	SUITE 106
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-2168
Country	:	US
Telephone Number	:	213-380-2008
Fax Number	:	213-484-0758

Provider Business Practice Location Address
First Line	:	2815 W. SUNSET BLVD.
Second Line	:	SUITE 106
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-2168
Country	:	US
Telephone Number	:	213-380-2008
Fax Number	:	213-484-0758

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	JOSEPH R. MICHERI
Credential	:	DDS
Telephone Number	:	213-380-2008

Provider Enumeration Date	:	10/05/2010
Last Update Date	:	10/05/2010

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