Provider Demographics
NPI:1326501891
Name:NIGOGHOSIAN DENTAL GROUP INC
Entity Type:Organization
Organization Name:NIGOGHOSIAN DENTAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:V
Authorized Official - Last Name:NIGOGHOSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-596-1155
Mailing Address - Street 1:2488 FOOTHILL BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-3062
Mailing Address - Country:US
Mailing Address - Phone:909-596-1155
Mailing Address - Fax:
Practice Address - Street 1:2488 FOOTHILL BLVD STE C
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-3062
Practice Address - Country:US
Practice Address - Phone:909-596-1155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-10
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty