Provider Demographics
NPI:1114078052
Name:GRKIKIAN, JOURIY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOURIY
Middle Name:
Last Name:GRKIKIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14847 MAGNOLIA BLVD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1329
Mailing Address - Country:US
Mailing Address - Phone:818-986-4600
Mailing Address - Fax:818-986-2310
Practice Address - Street 1:14847 MAGNOLIA BLVD
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1329
Practice Address - Country:US
Practice Address - Phone:818-986-4600
Practice Address - Fax:818-986-2310
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA414121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG91935-01Medicaid