MEDICARE: MHER GRIGORYAN DDS

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	53219	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

General Provider Information

NPI Number	:	1730169392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MHER GRIGORYAN DDS

Provider Business Mailing Address
First Line	:	2036 LINCOLN AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91103-1323
Country	:	US
Telephone Number	:	747-272-9649
Fax Number	:

Provider Business Practice Location Address
First Line	:	2036 LINCOLN AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91103-1323
Country	:	US
Telephone Number	:	626-797-6555
Fax Number	:

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

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	06/16/2022

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