Provider Demographics
NPI:1740424100
Name:MICHAEL ABAIAN DDS INC
Entity Type:Organization
Organization Name:MICHAEL ABAIAN DDS INC
Other - Org Name:GAGE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:ABAIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-788-8787
Mailing Address - Street 1:4327 GAGE AVE
Mailing Address - Street 2:
Mailing Address - City:BELL
Mailing Address - State:CA
Mailing Address - Zip Code:90201-1214
Mailing Address - Country:US
Mailing Address - Phone:323-773-5325
Mailing Address - Fax:
Practice Address - Street 1:4327 GAGE AVE
Practice Address - Street 2:
Practice Address - City:BELL
Practice Address - State:CA
Practice Address - Zip Code:90201-1214
Practice Address - Country:US
Practice Address - Phone:323-773-5325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-28
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53049122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty