Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 37332 | CA |
NPI | 1063597417 |
---|---|
Provider Name | Dr. Edith Gevorgian |
First Address | Glendale, CA 91207 |
Second Address | Glendale, CA 91207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 08/07/2007 |