| Jack Shabanian, D.d.s. Inc. | |
|
11701 Hawthorne Blvd Hawthorne CA 90250-2317 | |
| (310) 676-0145 | |
| (310) 676-3161 |
| Full Name | Jack Shabanian, D.d.s. Inc. |
|---|---|
| Speciality | Dentist |
| Location | 11701 Hawthorne Blvd, Hawthorne, California |
| Authorized Official Name and Position | Jack Shabanian (PRESIDENT) |
| Authorized Official Contact | 3106760145 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jack Shabanian, D.d.s. Inc. 11701 Hawthorne Blvd Hawthorne CA 90250-2317 Ph: (310) 676-0145 | Jack Shabanian, D.d.s. Inc. 11701 Hawthorne Blvd Hawthorne CA 90250-2317 Ph: (310) 676-0145 |
| NPI Number | 1538249222 |
|---|---|
| Provider Enumeration Date | 10/17/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538249222 | NPI | - | NPPES |
| G9112501 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 38917 (California) | Primary |
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