Provider Demographics
NPI:1447771100
Name:GYOKCHYAN, TIGRAN (DDS)
Entity Type:Individual
Prefix:
First Name:TIGRAN
Middle Name:
Last Name:GYOKCHYAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 N HOLLYWOOD WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-2224
Mailing Address - Country:US
Mailing Address - Phone:818-747-9670
Mailing Address - Fax:
Practice Address - Street 1:1209 N HOLLYWOOD WAY # 100
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-2224
Practice Address - Country:US
Practice Address - Phone:818-747-9670
Practice Address - Fax:818-747-9670
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1014761223G0001X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice