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NPI Code Detail

MEDICARE: MIRZOYAN DENTAL CORPORATION

MEDICARE: MIRZOYAN 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
11223G0001XGeneral Practice Dentistry59938CA

General Provider Information

NPI Number : 1952675977
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIRZOYAN DENTAL CORPORATION
Provider Business Mailing Address
First Line : 1127 N PACIFIC AVE
Second Line :
City : GLENDALE
State : CA
Zip : 91202-2358
Country : US
Telephone Number : 818-551-1127
Fax Number : 818-551-1167
Provider Business Practice Location Address
First Line : 1127 N PACIFIC AVE
Second Line :
City : GLENDALE
State : CA
Zip : 91202-2358
Country : US
Telephone Number : 818-551-1127
Fax Number : 818-551-1167
Authorized Official
Title or Position : CEO
Name : LILIT MIRZOYAN
Credential : DDS
Telephone Number : 818-551-1127
Provider Enumeration Date : 03/08/2012
Last Update Date : 03/08/2012

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Directions to “MIRZOYAN DENTAL CORPORATION ” Practice Location

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