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NPI Code Detail

MEDICARE: MISSAGH PEZESHKIAN, D.D. S., A PROFESSIONAL CORPORATION

MEDICARE: MISSAGH PEZESHKIAN, D.D. S., A PROFESSIONAL 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
11223G0001XGeneral Practice Dentistry51440CA

General Provider Information

NPI Number : 1578062121
Entity Type Code : Organization
Provider Name (Legal Business Name) : MISSAGH PEZESHKIAN, D.D. S., A PROFESSIONAL CORPORATION
Provider Business Mailing Address
First Line : 1016 E BROADWAY STE 104
Second Line :
City : GLENDALE
State : CA
Zip : 91205-4534
Country : US
Telephone Number : 818-409-0999
Fax Number : 818-543-0999
Provider Business Practice Location Address
First Line : 1016 E BROADWAY STE 104
Second Line :
City : GLENDALE
State : CA
Zip : 91205-4534
Country : US
Telephone Number : 818-409-0999
Fax Number : 818-543-0999
Authorized Official
Title or Position : CEO
Name : DR. MISSAGH PEZESHKIAN
Credential : DDDS
Telephone Number : 818-409-0999
Provider Enumeration Date : 02/09/2018
Last Update Date : 02/09/2018

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