MEDICARE: DR. HAROUTUNE AJDAHARIAN 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	122300000X	Dentist	29917	CA

General Provider Information

NPI Number	:	1720175722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HAROUTUNE AJDAHARIAN D.D.S.

Provider Business Mailing Address
First Line	:	5101 SANTA MONICA BLVD STE 15
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-2481
Country	:	US
Telephone Number	:	323-665-5423
Fax Number	:	323-665-3101

Provider Business Practice Location Address
First Line	:	5101 SANTA MONICA BLVD STE 15
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-2481
Country	:	US
Telephone Number	:	323-665-5423
Fax Number	:	323-665-3101

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/08/2007

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