Provider Demographics
NPI:1215556170
Name:ANANYAN DENTAL CORPORATION
Entity Type:Organization
Organization Name:ANANYAN DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANANYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:704-246-9194
Mailing Address - Street 1:620 E PALM AVE APT 302
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501-2868
Mailing Address - Country:US
Mailing Address - Phone:704-246-9194
Mailing Address - Fax:
Practice Address - Street 1:1101 N PACIFIC AVE STE 206
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-4367
Practice Address - Country:US
Practice Address - Phone:704-246-9194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental