Healthcare Provider Details

I. General information

NPI: 1174294052
Provider Name (Legal Business Name): LIANNA DAMARGI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2021
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 GRIFFITH PARK BLVD
LOS ANGELES CA
90039-2520
US

IV. Provider business mailing address

533 CLAYTON AVE
VESTAL NY
13850-3105
US

V. Phone/Fax

Practice location:
  • Phone: 323-660-5522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number063637
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS043388
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: