Provider Demographics
NPI:1235512864
Name:ABOOLIAN, ARBI DANIEL (DMD)
Entity Type:Individual
Prefix:
First Name:ARBI
Middle Name:DANIEL
Last Name:ABOOLIAN
Suffix:
Gender:M
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 E BROADWAY STE 102
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-4912
Mailing Address - Country:US
Mailing Address - Phone:818-484-0620
Mailing Address - Fax:
Practice Address - Street 1:520 E BROADWAY STE 102
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-4912
Practice Address - Country:US
Practice Address - Phone:818-484-0620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA646201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice