Provider Demographics
NPI:1053458059
Name:ARAKELYAN, TIGRAN
Entity Type:Individual
Prefix:
First Name:TIGRAN
Middle Name:
Last Name:ARAKELYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 N LAKE AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-5810
Mailing Address - Country:US
Mailing Address - Phone:626-808-9797
Mailing Address - Fax:626-808-9786
Practice Address - Street 1:720 N LAKE AVE STE 7
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-5810
Practice Address - Country:US
Practice Address - Phone:626-808-9797
Practice Address - Fax:626-808-9786
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA467381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice