MEDICARE: SHAHANGIAN 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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1669146684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHAHANGIAN DENTAL CORP.

Provider Business Mailing Address
First Line	:	4821 LANKERSHIM BLVD STE B
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91601-4572
Country	:	US
Telephone Number	:	818-508-7300
Fax Number	:	818-301-2566

Provider Business Practice Location Address
First Line	:	4821 LANKERSHIM BLVD STE B
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91601-4572
Country	:	US
Telephone Number	:	818-508-7300
Fax Number	:	818-301-2566

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	BITA SHAHANGIAN
Credential	:	DDS
Telephone Number	:	818-508-7300

Provider Enumeration Date	:	08/03/2021
Last Update Date	:	08/03/2021

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Directions to “SHAHANGIAN DENTAL CORP. ” Practice Location

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