Provider Demographics
NPI:1407579972
Name:EHTESSABIAN, ARMITA (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:ARMITA
Middle Name:
Last Name:EHTESSABIAN
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20265 CHANDLER DR
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-3286
Mailing Address - Country:US
Mailing Address - Phone:714-980-0764
Mailing Address - Fax:
Practice Address - Street 1:3233 GRAND AVE STE E
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-1489
Practice Address - Country:US
Practice Address - Phone:909-628-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1046651223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty