MEDICARE: KARINEH AVANESS DMD 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

General Provider Information

NPI Number	:	1770113029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KARINEH AVANESS DMD INC

Provider Business Mailing Address
First Line	:	4955 VAN NUYS BLVD STE 202
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-1820
Country	:	US
Telephone Number	:	818-471-5231
Fax Number	:

Provider Business Practice Location Address
First Line	:	4955 VAN NUYS BLVD STE 202
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-1820
Country	:	US
Telephone Number	:	818-471-5231
Fax Number	:

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. KARINEH AVANESS
Credential	:	DMD
Telephone Number	:	818-471-5231

Provider Enumeration Date	:	01/24/2020
Last Update Date	:	01/24/2020

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