MEDICARE: DR. ROXAN CAROL HUMES 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	41092	CA

General Provider Information

NPI Number	:	1669579330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROXAN CAROL HUMES D.D.S.

Provider Business Mailing Address
First Line	:	3911 OLYMPIAD DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90043-1131
Country	:	US
Telephone Number	:	323-296-6170
Fax Number	:

Provider Business Practice Location Address
First Line	:	3756 SANTA ROSALIA DR
Second Line	:	500
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-3606
Country	:	US
Telephone Number	:	323-294-1170
Fax Number	:	323-295-0286

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

Provider Enumeration Date	:	09/17/2006
Last Update Date	:	01/25/2008

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Directions to “ DR. ROXAN CAROL HUMES D.D.S.” Practice Location

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