MEDICARE: SAN GABRIAL FAMILY DENTAL CENTER

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1467204982
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN GABRIAL FAMILY DENTAL CENTER

Provider Business Mailing Address
First Line	:	2684 E COLORADO BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-3726
Country	:	US
Telephone Number	:	626-577-5585
Fax Number	:	626-577-7075

Provider Business Practice Location Address
First Line	:	2684 E COLORADO BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-3726
Country	:	US
Telephone Number	:	626-577-5585
Fax Number	:	626-577-7075

Authorized Official
Title or Position	:	DDS
Name	:	DR. VICKEN MARGANIAN
Credential	:	DDS
Telephone Number	:	626-577-5585

Provider Enumeration Date	:	04/05/2024
Last Update Date	:	04/05/2024

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