MEDICARE: DR. ARMEN JOSEPH PEZESHKIAN 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	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	101525	CA

General Provider Information

NPI Number	:	1952841900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARMEN JOSEPH PEZESHKIAN DDS

Provider Business Mailing Address
First Line	:	1172 OLD PHILLIPS RD
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91207-1112
Country	:	US
Telephone Number	:	818-644-0542
Fax Number	:

Provider Business Practice Location Address
First Line	:	1016 E BROADWAY STE 104
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-4534
Country	:	US
Telephone Number	:	818-409-0999
Fax Number	:

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

Provider Enumeration Date	:	02/23/2017
Last Update Date	:	11/29/2023

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