Provider Demographics
NPI:1376077289
Name:B. DEIRMENJIAN, DDS, INC
Entity Type:Organization
Organization Name:B. DEIRMENJIAN, DDS, INC
Other - Org Name:SMILES WEST DENTAL AND BRACES OF HUNTINGTON PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BAROUIR
Authorized Official - Middle Name:ASHRAG
Authorized Official - Last Name:DEIRMENJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:855-705-3434
Mailing Address - Street 1:15643 SHERMAN WAY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-4135
Mailing Address - Country:US
Mailing Address - Phone:855-705-3434
Mailing Address - Fax:855-705-3399
Practice Address - Street 1:5501 PACIFIC BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-2534
Practice Address - Country:US
Practice Address - Phone:323-586-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:B. DEIRMENJIAN, DDS,INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40804122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty