Provider Demographics
NPI:1043926959
Name:NINETTE HACOPIAN DDS, INC
Entity Type:Organization
Organization Name:NINETTE HACOPIAN DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NINETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:HACOPIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-922-4261
Mailing Address - Street 1:3174 BEAUDRY TER
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1745
Mailing Address - Country:US
Mailing Address - Phone:818-922-4261
Mailing Address - Fax:
Practice Address - Street 1:859 N FAIR OAKS AVE STE 120
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-3078
Practice Address - Country:US
Practice Address - Phone:818-873-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1609246792Medicaid