Provider Demographics
NPI:1093861882
Name:GALLATIN DENTAL GROUP
Entity Type:Organization
Organization Name:GALLATIN DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:AIVAZIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:562-869-1686
Mailing Address - Street 1:10805 PARAMOUNT BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241
Mailing Address - Country:US
Mailing Address - Phone:562-869-1686
Mailing Address - Fax:562-861-1672
Practice Address - Street 1:10805 PARAMOUNT BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241
Practice Address - Country:US
Practice Address - Phone:562-869-1686
Practice Address - Fax:562-861-1672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41887122300000X
CA47500122300000X
CA420151223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty