MEDICARE: MR. JOSEPH R MICHERI 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	1223G0001X	General Practice Dentistry	DV-036583	CA

General Provider Information

NPI Number	:	1790899664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH R MICHERI DDS

Provider Business Mailing Address
First Line	:	2815 SUNSET BLVD
Second Line	:	SUITE 106
City	:	LOS ANGELES
State	:	CA
Zip	:	90026
Country	:	US
Telephone Number	:	213-380-2008
Fax Number	:	213-484-0758

Provider Business Practice Location Address
First Line	:	2815 SUNSET BLVD
Second Line	:	SUITE 106
City	:	LOS ANGELES
State	:	CA
Zip	:	90026
Country	:	US
Telephone Number	:	213-380-2008
Fax Number	:	213-484-0758

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

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	07/08/2007

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