MEDICARE: DR. HARRY L JOBOULIAN 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	1223G0001X	General Practice Dentistry	11069	MI

General Provider Information

NPI Number	:	1760551964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HARRY L JOBOULIAN D.D.S.

Provider Business Mailing Address
First Line	:	31574 SCHOOLCRAFT RD
Second Line	:
City	:	LIVONIA
State	:	MI
Zip	:	48150-1805
Country	:	US
Telephone Number	:	734-425-4530
Fax Number	:	734-425-5872

Provider Business Practice Location Address
First Line	:	31574 SCHOOLCRAFT RD
Second Line	:
City	:	LIVONIA
State	:	MI
Zip	:	48150-1805
Country	:	US
Telephone Number	:	734-425-4530
Fax Number	:	734-425-5872

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	07/08/2007

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