Provider Demographics
NPI:1437568029
Name:ARAKELYAN AZNAVOUR DENTAL CORPORATION
Entity Type:Organization
Organization Name:ARAKELYAN AZNAVOUR DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ARAKELYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-786-6204
Mailing Address - Street 1:175 N PENNSYLVANIA AVE #3
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:175 N PENNSYLVANIA AVE #3
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741
Practice Address - Country:US
Practice Address - Phone:626-786-6204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52709122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty