MEDICARE: ANDRE ELIASIAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	62927	CA
2	122300000X	Dentist	62927	CA

General Provider Information

NPI Number	:	1023443454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDRE ELIASIAN DDS

Provider Business Mailing Address
First Line	:	1249 W GLENOAKS BLVD
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91201-2238
Country	:	US
Telephone Number	:	818-649-1772
Fax Number	:	818-649-1774

Provider Business Practice Location Address
First Line	:	1249 W GLENOAKS BLVD
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91201-2238
Country	:	US
Telephone Number	:	818-649-1772
Fax Number	:	818-649-1774

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2013
Last Update Date	:	04/22/2024

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