MEDICARE: DIMITRI BIZOUMIS, 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	122300000X	Dentist

General Provider Information

NPI Number	:	1811619588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIMITRI BIZOUMIS, DDS, INC

Provider Business Mailing Address
First Line	:	6452 BOLSA AVE
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-2599
Country	:	US
Telephone Number	:	714-898-3882
Fax Number	:	714-890-1025

Provider Business Practice Location Address
First Line	:	6452 BOLSA AVE
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-2599
Country	:	US
Telephone Number	:	714-898-3882
Fax Number	:	714-890-1025

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DIMITRI BIZOUMIS
Credential	:	DDS
Telephone Number	:	310-926-3311

Provider Enumeration Date	:	09/19/2022
Last Update Date	:	09/19/2022

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