Provider Demographics
NPI:1043566284
Name:MARDIROSIAN, MARTIN H (DDS, MS)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:H
Last Name:MARDIROSIAN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20047 CHAPTER DR
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-5669
Mailing Address - Country:US
Mailing Address - Phone:818-396-6278
Mailing Address - Fax:
Practice Address - Street 1:20047 CHAPTER DR
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-5669
Practice Address - Country:US
Practice Address - Phone:818-396-6278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA611601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice