Provider Demographics
NPI:1063669356
Name:BAYRAKDARIAN ORTHODONTICS LLC
Entity Type:Organization
Organization Name:BAYRAKDARIAN ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:ISHKHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYRAKDARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-522-2121
Mailing Address - Street 1:451 CLOVIS AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-1194
Mailing Address - Country:US
Mailing Address - Phone:559-298-4322
Mailing Address - Fax:
Practice Address - Street 1:451 CLOVIS AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-1194
Practice Address - Country:US
Practice Address - Phone:559-298-4322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA500371223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty