Provider Demographics
NPI:1003041302
Name:MANOUKIAN, ARTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ARTIN
Middle Name:
Last Name:MANOUKIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3151
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91221-0151
Mailing Address - Country:US
Mailing Address - Phone:818-795-0967
Mailing Address - Fax:
Practice Address - Street 1:2307 FLORENCITA AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CA
Practice Address - Zip Code:91020-1817
Practice Address - Country:US
Practice Address - Phone:818-249-1146
Practice Address - Fax:818-249-9612
Is Sole Proprietor?:No
Enumeration Date:2009-05-16
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54750122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist