Provider Demographics
NPI:1114452737
Name:ABRAHAM GHORBANIAN DDS, INC
Entity Type:Organization
Organization Name:ABRAHAM GHORBANIAN DDS, INC
Other - Org Name:BEVERLY HILLS DENTAL SPECIALISTS /AAVA DENTAL OF BEVERLY HILLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GHORBANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-450-0076
Mailing Address - Street 1:8920 WILSHIRE BLVD STE 601
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1960
Mailing Address - Country:US
Mailing Address - Phone:310-659-1999
Mailing Address - Fax:
Practice Address - Street 1:8920 WILSHIRE BLVD STE 601
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1960
Practice Address - Country:US
Practice Address - Phone:310-659-1999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53515122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty