MEDICARE: DR. RENE AVANS DER GREGORIAN D.M.D.

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	58165	CA

General Provider Information

NPI Number	:	1285612416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RENE AVANS DER GREGORIAN D.M.D.

Provider Business Mailing Address
First Line	:	1255 N VIRGIL AVE
Second Line	:	#1
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-2024
Country	:	US
Telephone Number	:	818-653-3825
Fax Number	:

Provider Business Practice Location Address
First Line	:	988 E WASHINGTON BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91104-2438
Country	:	US
Telephone Number	:	626-296-6600
Fax Number	:

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

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	02/02/2026

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