Provider Demographics
NPI:1073825956
Name:VARAND KERIKORIAN, DDS A PROFESSIONAL DENTAL CORP
Entity Type:Organization
Organization Name:VARAND KERIKORIAN, DDS A PROFESSIONAL DENTAL CORP
Other - Org Name:GREEN CALIFORNIA DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VARAND
Authorized Official - Middle Name:
Authorized Official - Last Name:KERIKORIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-636-6923
Mailing Address - Street 1:1822 W BURBANK BLVD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-1348
Mailing Address - Country:US
Mailing Address - Phone:818-238-9700
Mailing Address - Fax:818-238-9124
Practice Address - Street 1:1822 W BURBANK BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-1348
Practice Address - Country:US
Practice Address - Phone:818-238-9700
Practice Address - Fax:818-238-9124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57533122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty