Provider Demographics
NPI:1235273723
Name:MIKALIAN, MELINEH (DMD)
Entity Type:Individual
Prefix:
First Name:MELINEH
Middle Name:
Last Name:MIKALIAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 OLMSTED DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-1512
Mailing Address - Country:US
Mailing Address - Phone:818-245-0131
Mailing Address - Fax:
Practice Address - Street 1:418 E GLENOAKS BLVD
Practice Address - Street 2:UNIT 202
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91207-2035
Practice Address - Country:US
Practice Address - Phone:818-244-5052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA554451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice