Provider Demographics
NPI:1245567734
Name:I. SHAHINYAN D.D.S, INCORPORATED
Entity Type:Organization
Organization Name:I. SHAHINYAN D.D.S, INCORPORATED
Other - Org Name:SMILES DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHINYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-252-2800
Mailing Address - Street 1:18520 SOLEDAD CANYON RD STE G
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-3731
Mailing Address - Country:US
Mailing Address - Phone:661-252-2800
Mailing Address - Fax:661-252-2810
Practice Address - Street 1:18520 SOLEDAD CANYON RD STE G
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91351-3731
Practice Address - Country:US
Practice Address - Phone:661-252-2800
Practice Address - Fax:661-252-2810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA537301223G0001X, 305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty