Provider Demographics
NPI:1114195773
Name:GRIGORIAN, FREDRICK (DENTIST)
Entity Type:Individual
Prefix:DR
First Name:FREDRICK
Middle Name:
Last Name:GRIGORIAN
Suffix:
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8454 SUNLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-3436
Mailing Address - Country:US
Mailing Address - Phone:818-415-7556
Mailing Address - Fax:818-714-2358
Practice Address - Street 1:8454 SUNLAND BLVD
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-3436
Practice Address - Country:US
Practice Address - Phone:818-767-1800
Practice Address - Fax:818-714-2358
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-18
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54143122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA54143OtherDENTI-CAL