MEDICARE: BURBANK TAROIAN DENTAL INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	1223E0200X	Endodontics
2	1223G0001X	General Practice Dentistry
3	1223S0112X	Oral and Maxillofacial Surgery (Dentist)
4	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry
5	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1750057535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BURBANK TAROIAN DENTAL INC

Provider Business Mailing Address
First Line	:	4406 W MAGNOLIA BLVD
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-2729
Country	:	US
Telephone Number	:	818-260-0274
Fax Number	:

Provider Business Practice Location Address
First Line	:	4406 W MAGNOLIA BLVD
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-2729
Country	:	US
Telephone Number	:	818-260-0274
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HARMICK TAROIAN
Credential	:	DDS
Telephone Number	:	818-260-0274

Provider Enumeration Date	:	08/20/2021
Last Update Date	:	08/20/2021

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