Provider Demographics
NPI:1093983314
Name:GRIGORIAN, NUNE (DDS)
Entity Type:Individual
Prefix:
First Name:NUNE
Middle Name:
Last Name:GRIGORIAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10160 SULLY DR
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-4257
Mailing Address - Country:US
Mailing Address - Phone:818-823-6197
Mailing Address - Fax:
Practice Address - Street 1:10160 SULLY DR
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-4257
Practice Address - Country:US
Practice Address - Phone:818-823-6197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA566751223G0001X
TX251141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice