MEDICARE: BOYAJIAN DENTAL GROUP

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	261QS0112X	Oral and Maxillofacial Surgery Clinic/Center

General Provider Information

NPI Number	:	1932666369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOYAJIAN DENTAL GROUP

Provider Business Mailing Address
First Line	:	6206 W 87TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3902
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6206 W 87TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3902
Country	:	US
Telephone Number	:	310-670-6944
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ARTO BOYAJIAN
Credential	:
Telephone Number	:	310-670-6944

Provider Enumeration Date	:	02/21/2019
Last Update Date	:	02/21/2019

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