Provider Demographics
NPI:1235211541
Name:GRIGORYAN, VAHAN (DDS)
Entity Type:Individual
Prefix:
First Name:VAHAN
Middle Name:
Last Name:GRIGORYAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 E FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3955
Mailing Address - Country:US
Mailing Address - Phone:909-291-8625
Mailing Address - Fax:909-291-8629
Practice Address - Street 1:536 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3955
Practice Address - Country:US
Practice Address - Phone:909-291-8625
Practice Address - Fax:909-291-8629
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49536122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist