MEDICARE: DR. BENJAMIN MESHKINFAM 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	122300000X	Dentist	62734	CA

General Provider Information

NPI Number	:	1982962023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENJAMIN MESHKINFAM DDS

Provider Business Mailing Address
First Line	:	4725 LANKERSHIM BLVD
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91602-1803
Country	:	US
Telephone Number	:	818-766-3775
Fax Number	:

Provider Business Practice Location Address
First Line	:	4725 LANKERSHIM BLVD
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91602-1803
Country	:	US
Telephone Number	:	818-766-3775
Fax Number	:

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

Provider Enumeration Date	:	04/26/2012
Last Update Date	:	10/23/2013

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