MEDICARE: DR. HAMLET S. AVANESIAN 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	122300000X	Dentist	50563	CA
2	1223G0001X	General Practice Dentistry	50563	CA

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	:	1437260080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HAMLET S. AVANESIAN DDS

Provider Business Mailing Address
First Line	:	316 E BROADWAY
Second Line	:	SUITE A
City	:	GLENDALE
State	:	CA
Zip	:	91205-1011
Country	:	US
Telephone Number	:	818-548-7700
Fax Number	:	818-548-7697

Provider Business Practice Location Address
First Line	:	316 E BROADWAY
Second Line	:	SUITE A
City	:	GLENDALE
State	:	CA
Zip	:	91205-1011
Country	:	US
Telephone Number	:	818-548-7700
Fax Number	:	818-548-7697

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	03/19/2010

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