Provider Demographics
NPI:1245739150
Name:HARTOUNIAN DENTAL GROUP INC.
Entity Type:Organization
Organization Name:HARTOUNIAN DENTAL GROUP INC.
Other - Org Name:DENTAL CENTER OF SIMI VALLEY
Other - Org Type:Other Name
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:HARMIK
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTOUNIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:818-579-0600
Mailing Address - Street 1:4210 E LOS ANGELES AVE STE F
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-3300
Mailing Address - Country:US
Mailing Address - Phone:805-579-0600
Mailing Address - Fax:818-579-3792
Practice Address - Street 1:4210 E LOS ANGELES AVE STE F
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063
Practice Address - Country:US
Practice Address - Phone:805-579-0600
Practice Address - Fax:818-579-3792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60744122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty