MEDICARE: DR. ANDRE MICHAELIAN 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	3076	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265578587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDRE MICHAELIAN DDS

Provider Business Mailing Address
First Line	:	8430 W LAKE MEAD BLVD
Second Line	:	SUITE 150
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-7672
Country	:	US
Telephone Number	:	702-220-9100
Fax Number	:	702-220-9104

Provider Business Practice Location Address
First Line	:	8430 W LAKE MEAD BLVD
Second Line	:	SUITE 150
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-7672
Country	:	US
Telephone Number	:	702-220-9100
Fax Number	:	702-220-9104

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	02/13/2020

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