Healthcare Provider Details

I. General information

NPI: 1518525104
Provider Name (Legal Business Name): GEVIK MARCARIAN DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2019
Last Update Date: 05/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16661 VENTURA BLVD STE 611
ENCINO CA
91436-1984
US

IV. Provider business mailing address

16661 VENTURA BLVD STE 611
ENCINO CA
91436-1984
US

V. Phone/Fax

Practice location:
  • Phone: 818-285-0528
  • Fax:
Mailing address:
  • Phone: 818-285-0528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GEVIK MARCARIAN
Title or Position: OWNER
Credential: DDS
Phone: 818-285-0528