Provider Demographics
NPI:1407953466
Name:SHAHANGIAN, BITA (DDS)
Entity Type:Individual
Prefix:DR
First Name:BITA
Middle Name:
Last Name:SHAHANGIAN
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 1:4821 LANKERSHIM BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-4572
Mailing Address - Country:US
Mailing Address - Phone:818-508-7300
Mailing Address - Fax:818-301-2566
Practice Address - Street 1:4821 LANKERSHIM BLVD STE B
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-4572
Practice Address - Country:US
Practice Address - Phone:818-508-7300
Practice Address - Fax:818-301-2566
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA440821223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA986867OtherUNITED CONCORDIA
CAB44082-02Medicaid