MEDICARE: DR. BITA SHAHANGIAN D.D.S.

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	44082	CA
2	122300000X	Dentist	44082	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	986867	OTHER	CA	UNITED CONCORDIA

General Provider Information

NPI Number	:	1407953466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BITA SHAHANGIAN D.D.S.

Provider Business Mailing Address
First Line	:	4821 LANKERSHIM BLVD STE B
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91601-4572
Country	:	US
Telephone Number	:	818-508-7300
Fax Number	:	818-301-2566

Provider Business Practice Location Address
First Line	:	4821 LANKERSHIM BLVD STE B
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91601-4572
Country	:	US
Telephone Number	:	818-508-7300
Fax Number	:	818-301-2566

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/30/2021

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