Provider Demographics
NPI:1386679876
Name:KECHECHYAN, ANUSH (DDS)
Entity Type:Individual
Prefix:MRS
First Name:ANUSH
Middle Name:
Last Name:KECHECHYAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1741 W. GLENOAKS BLVD., UNIT B
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201
Mailing Address - Country:US
Mailing Address - Phone:818-246-0109
Mailing Address - Fax:818-246-7073
Practice Address - Street 1:1741 W. GLENOAKS BLVD., UNIT B
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201
Practice Address - Country:US
Practice Address - Phone:818-246-0109
Practice Address - Fax:818-246-7073
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA419291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice