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General NPI Number Information
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NPI Number | 1710556550
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Entity Type | Organization
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Legal Business Name | WESTERNOFF DMD MD & MARDIROSIAN DDS MD GP-W
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Dates
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Enumeration Date | 06/24/2021
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Last Update Date | 06/24/2021
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Provider Practice Location Address
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Address Line | 8540 S SEPULVEDA BLVD STE 1206
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City | LOS ANGELES
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State | CA
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Zip | 90045-3819
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Country | US
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Telephone | 310-375-0514
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Fax |
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Provider Business Mailing Address
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Address Line | 1706 S ELENA AVE STE A
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City | REDONDO BEACH
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State | CA
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Zip | 90277-5715
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Country | US
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Telephone | 310-375-0514
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Fax |
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Authorized Official
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Title or Position | ORAL SURGEON
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Name | MARTIN MARDIROSIAN
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Credential | DDS, MS, MD
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Telephone | 310-375-0514
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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