MEDICARE: DR. RODRIK AVRAND

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	109429	CA

General Provider Information

NPI Number	:	1790564540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RODRIK AVRAND

Provider Business Mailing Address
First Line	:	345 N JACKSON ST APT 303
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91206-3664
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	345 N JACKSON ST APT 303
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91206-3664
Country	:	US
Telephone Number	:	818-648-2825
Fax Number	:

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

Provider Enumeration Date	:	09/21/2023
Last Update Date	:	09/21/2023

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Directions to “ DR. RODRIK AVRAND ” Practice Location

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