Provider Demographics
NPI:1134329550
Name:ARAKELYAN DENTAL CORPORATION
Entity Type:Organization
Organization Name:ARAKELYAN DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TIGRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ARAKELYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-808-9797
Mailing Address - Street 1:720 N LAKE AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-5810
Mailing Address - Country:US
Mailing Address - Phone:626-808-9797
Mailing Address - Fax:
Practice Address - Street 1:720 N LAKE AVE STE 7
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-5810
Practice Address - Country:US
Practice Address - Phone:626-808-9797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46738122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7346OtherSAFEGUARD
CA1604070OtherUNITED CONCORDIA
CA556225OtherBLUE CROSS HMO
CA0008145OtherASSURANT EMPLOYEE BENEFIT
001592OtherCALIFORNIA DENTAL NETWORK
CA001746OtherPMI