MEDICARE: KAREN BAGHDASARYAN DENTAL 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
1	1223G0001X	General Practice Dentistry	50409	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	G9834801	OTHER	CA	BILLING PROVIDER

General Provider Information

NPI Number	:	1679780464
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAREN BAGHDASARYAN DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	6300 SAN FERNANDO RD
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91201-2414
Country	:	US
Telephone Number	:	818-547-4455
Fax Number	:	818-547-9955

Provider Business Practice Location Address
First Line	:	6300 SAN FERNANDO RD
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91201-2414
Country	:	US
Telephone Number	:	818-547-4455
Fax Number	:	818-547-9955

Authorized Official
Title or Position	:	CEO
Name	:	DR. KAREN BAGHDASARYAN
Credential	:	DDS
Telephone Number	:	818-547-4455

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	06/12/2008

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