MEDICARE: DR. HOVSEP NARGIZYAN 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	1223G0001X	General Practice Dentistry	51112	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1619568	OTHER	CA	UNITED CONCORDIA

General Provider Information

NPI Number	:	1982799276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOVSEP NARGIZYAN DDS

Provider Business Mailing Address
First Line	:	1655 N. MOUNT VERNON AVE.
Second Line	:	UNIT B
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92411
Country	:	US
Telephone Number	:	909-885-8707
Fax Number	:	909-885-9447

Provider Business Practice Location Address
First Line	:	1655 N. MOUNT VERNON AVE.
Second Line	:	UNIT B
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92411
Country	:	US
Telephone Number	:	909-885-8707
Fax Number	:	909-885-9447

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	07/08/2007

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