MEDICARE: GEORGETTE ZOUEIN DENTAL CORP

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	43991	CA

General Provider Information

NPI Number	:	1598166464
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGETTE ZOUEIN DENTAL CORP

Provider Business Mailing Address
First Line	:	4400 S BROADWAY STE 103
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90037-2792
Country	:	US
Telephone Number	:	323-233-9400
Fax Number	:	323-233-9977

Provider Business Practice Location Address
First Line	:	4400 S BROADWAY STE 103
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90037-2792
Country	:	US
Telephone Number	:	323-233-9400
Fax Number	:	323-233-9977

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GEORGETTE KHOURY ZOUEIN
Credential	:	DDS
Telephone Number	:	323-233-9400

Provider Enumeration Date	:	09/10/2014
Last Update Date	:	09/10/2014

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