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NPI Code Detail

MEDICARE: DR. MONIQUE NAIRI SELVIAN D.D.S.

MEDICARE:  DR. MONIQUE NAIRI SELVIAN  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
11223G0001XGeneral Practice Dentistry55372CA
21223P0221XPediatric Dentistry55372CA

General Provider Information

NPI Number : 1417089038
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MONIQUE NAIRI SELVIAN D.D.S.
Provider Business Mailing Address
First Line : 1886 VERDUGO LOMA DR
Second Line :
City : GLENDALE
State : CA
Zip : 91208-2811
Country : US
Telephone Number : 310-622-2828
Fax Number :
Provider Business Practice Location Address
First Line : 1127 E GREEN ST
Second Line :
City : PASADENA
State : CA
Zip : 91106-2505
Country : US
Telephone Number : 310-622-2828
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2007
Last Update Date : 07/24/2012

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Directions to “ DR. MONIQUE NAIRI SELVIAN D.D.S.” Practice Location

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