Provider Demographics
NPI:1154856250
Name:ABRAHAM GHORBANIAN DENTAL CORPORATION
Entity Type:Organization
Organization Name:ABRAHAM GHORBANIAN DENTAL CORPORATION
Other - Org Name:AAVA DENTAL OF RIVERSIDE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGEMENT DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GHORBANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-450-0076
Mailing Address - Street 1:10110 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-5346
Mailing Address - Country:US
Mailing Address - Phone:949-450-0076
Mailing Address - Fax:
Practice Address - Street 1:10110 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-5346
Practice Address - Country:US
Practice Address - Phone:951-977-8593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53515122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty