Healthcare Provider Details

I. General information

NPI: 1942752878
Provider Name (Legal Business Name): KARMEN MASSIH, DDS, MDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 N PACIFIC AVE SUITE A
GLENDALE CA
91202-2313
US

IV. Provider business mailing address

3401 SIERRA GLEN RD
GLENDALE CA
91208-1629
US

V. Phone/Fax

Practice location:
  • Phone: 818-507-1515
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number55083
License Number StateCA

VIII. Authorized Official

Name: DR. KARMEN MASSIH
Title or Position: PRESIDENT
Credential: DDS, MDS
Phone: 818-321-5505