MEDICARE: MR. GEORGE OGANESIAN

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	126900000X	Dental Laboratory Technician

General Provider Information

NPI Number	:	1376739227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GEORGE OGANESIAN

Provider Business Mailing Address
First Line	:	1006 CHARLES ST
Second Line	:	SUITE 4
City	:	NORTH PROVIDENCE
State	:	RI
Zip	:	02904
Country	:	US
Telephone Number	:	401-725-5777
Fax Number	:

Provider Business Practice Location Address
First Line	:	1006 CHARLES ST
Second Line	:	SUITE 4
City	:	NORTH PROVIDENCE
State	:	RI
Zip	:	02904
Country	:	US
Telephone Number	:	401-725-5777
Fax Number	:

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

Provider Enumeration Date	:	09/24/2007
Last Update Date	:	09/24/2007

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