Provider Demographics
NPI:1114132925
Name:BOGHOSIAN, NATASHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATASHA
Middle Name:
Last Name:BOGHOSIAN
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 1:25424 VIA MACARENA
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-2918
Mailing Address - Country:US
Mailing Address - Phone:818-219-5147
Mailing Address - Fax:
Practice Address - Street 1:250 N ROBERTSON BLVD
Practice Address - Street 2:SUITE 412
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1788
Practice Address - Country:US
Practice Address - Phone:310-271-3003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49844122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist