MEDICARE: DR. GEORGE DEBBANEH DDS

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	34083	CA

General Provider Information

NPI Number	:	1942202742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE DEBBANEH DDS

Provider Business Mailing Address
First Line	:	927 N LA BREA AVE
Second Line	:
City	:	INGLEWOOD
State	:	CA
Zip	:	90302-2207
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	927 N LA BREA AVE
Second Line	:
City	:	INGLEWOOD
State	:	CA
Zip	:	90302-2207
Country	:	US
Telephone Number	:	310-330-9200
Fax Number	:	310-330-9220

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	07/08/2007

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