MEDICARE: NARGES MENALAGHA, D.D.S., A PROFESSIONAL DENTAL CORPORATION

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	61456	CA

General Provider Information

NPI Number	:	1871917096
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NARGES MENALAGHA, D.D.S., A PROFESSIONAL DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	6345 BALBOA BLVD STE 314
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91316-1500
Country	:	US
Telephone Number	:	818-600-8667
Fax Number	:	818-600-8668

Provider Business Practice Location Address
First Line	:	6345 BALBOA BLVD STE 314
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91316-1500
Country	:	US
Telephone Number	:	818-600-8667
Fax Number	:	818-600-8668

Authorized Official
Title or Position	:	OWNER
Name	:	DR. NARGES MENALAGHA
Credential	:	DDS
Telephone Number	:	818-600-8667

Provider Enumeration Date	:	02/07/2014
Last Update Date	:	06/19/2019

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