MEDICARE: DR. GOAR GRIGORIAN 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	45868	CA

General Provider Information

NPI Number	:	1508085622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GOAR GRIGORIAN D.D.S.

Provider Business Mailing Address
First Line	:	3161 LOS FELIZ BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-1522
Country	:	US
Telephone Number	:	323-663-2606
Fax Number	:	323-906-0072

Provider Business Practice Location Address
First Line	:	3161 LOS FELIZ BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-1522
Country	:	US
Telephone Number	:	323-663-2606
Fax Number	:	323-906-0072

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	07/08/2007

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