Provider Demographics
NPI:1164572053
Name:HOVSEP NARGIZYAN, DDS, INC.
Entity Type:Organization
Organization Name:HOVSEP NARGIZYAN, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOVSEP
Authorized Official - Middle Name:
Authorized Official - Last Name:NARGIZYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-885-8707
Mailing Address - Street 1:1655 N MOUNT VERNON AVE
Mailing Address - Street 2:UNIT B
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92411-1427
Mailing Address - Country:US
Mailing Address - Phone:909-885-8707
Mailing Address - Fax:909-885-9447
Practice Address - Street 1:1655 N MOUNT VERNON AVE
Practice Address - Street 2:UNIT B
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411-1427
Practice Address - Country:US
Practice Address - Phone:909-885-8707
Practice Address - Fax:909-885-9447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA511121223G0001X
CA550321223P0221X
CA510821223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA161-9568OtherUNITED CONCORDIA
CAG94087-01OtherDENTI-CAL