Provider Demographics
NPI:1235662545
Name:ARKELAKYAN, ARTUR
Entity Type:Individual
Prefix:
First Name:ARTUR
Middle Name:
Last Name:ARKELAKYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 N BELMONT ST APT 110
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4402
Mailing Address - Country:US
Mailing Address - Phone:818-640-8013
Mailing Address - Fax:
Practice Address - Street 1:905 S LAKE ST STE 102
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-2436
Practice Address - Country:US
Practice Address - Phone:818-859-7979
Practice Address - Fax:818-859-7249
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-05
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101249122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist