Provider Demographics
NPI:1346339173
Name:SHANAKIAN, TOM V (DDS)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:V
Last Name:SHANAKIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9249 CANTER LN
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-3733
Mailing Address - Country:US
Mailing Address - Phone:818-314-4246
Mailing Address - Fax:
Practice Address - Street 1:5151 HAZELTINE AVE
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-1116
Practice Address - Country:US
Practice Address - Phone:818-788-2023
Practice Address - Fax:818-788-1830
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52113122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist