MEDICARE: LIANNA DAMARGI

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	122300000X	Dentist	063637	NY
2	122300000X	Dentist	DS043388	PA

General Provider Information

NPI Number	:	1174294052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIANNA DAMARGI

Provider Business Mailing Address
First Line	:	533 CLAYTON AVE
Second Line	:
City	:	VESTAL
State	:	NY
Zip	:	13850-3105
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2650 GRIFFITH PARK BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-2520
Country	:	US
Telephone Number	:	323-660-5522
Fax Number	:

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

Provider Enumeration Date	:	09/21/2021
Last Update Date	:	11/18/2025

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Directions to “ LIANNA DAMARGI ” Practice Location

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