MEDICARE: JOHN M. ABAJIAN DDS A DENTAL CORPORATION

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	:	1497199145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN M. ABAJIAN DDS A DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	29219 CANWOOD ST
Second Line	:	SUITE 250
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-1560
Country	:	US
Telephone Number	:	818-991-2626
Fax Number	:	818-991-0946

Provider Business Practice Location Address
First Line	:	29219 CANWOOD ST
Second Line	:	SUITE 250
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-1560
Country	:	US
Telephone Number	:	818-991-2626
Fax Number	:	818-991-0946

Authorized Official
Title or Position	:	CEO
Name	:	JOHN M. ABAJIAN
Credential	:	DDS
Telephone Number	:	818-991-2626

Provider Enumeration Date	:	04/24/2013
Last Update Date	:	04/24/2013

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