MEDICARE: DR. NISHAN M. ODABASHIAN DMD, MS

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	1223E0200X	Endodontics	39317	CA

General Provider Information

NPI Number	:	1841482494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NISHAN M. ODABASHIAN DMD, MS

Provider Business Mailing Address
First Line	:	2021 BRUNDAGE LN
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93304-2850
Country	:	US
Telephone Number	:	661-322-2071
Fax Number	:

Provider Business Practice Location Address
First Line	:	3975 S DURANGO DR
Second Line	:	SUITE 107
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-4156
Country	:	US
Telephone Number	:	702-367-3636
Fax Number	:

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

Provider Enumeration Date	:	08/16/2007
Last Update Date	:	08/16/2007

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