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General NPI Number Information
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NPI Number | 1437260080
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Entity Type | Individual
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Provider Name | HAMLET S. AVANESIAN DDS
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 03/19/2010
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Provider Practice Location Address
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Address Line | 316 E BROADWAY SUITE A
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City | GLENDALE
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State | CA
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Zip | 91205-1011
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Country | US
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Telephone | 818-548-7700
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Fax | 818-548-7697
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Provider Business Mailing Address
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Address Line | 316 E BROADWAY SUITE A
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City | GLENDALE
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State | CA
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Zip | 91205-1011
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Country | US
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Telephone | 818-548-7700
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Fax | 818-548-7697
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 50563
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 50563
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License Number State | CA
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