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General NPI Number Information
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NPI Number | 1750457628
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Entity Type | Organization
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Legal Business Name | GARY DEMERJIAN DDS INC
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Dates
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Enumeration Date | 11/24/2006
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Last Update Date | 04/26/2010
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Provider Practice Location Address
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Address Line | 2701 W ALAMEDA AVE SUITE 606
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City | BURBANK
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State | CA
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Zip | 91505-4402
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Country | US
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Telephone | 818-238-9865
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Fax | 818-238-9012
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Provider Business Mailing Address
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Address Line | 2701 W ALAMEDA AVE SUITE 606
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City | BURBANK
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State | CA
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Zip | 91505-4402
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Country | US
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Telephone | 818-238-9865
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Fax | 818-238-9012
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | FLORA DEMERJIAN
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Credential |
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Telephone | 818-238-9865
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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 | 38514
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License Number State | CA
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