Provider Demographics
NPI:1467740852
Name:OHANESSIAN, VAHE (DDS)
Entity Type:Individual
Prefix:DR
First Name:VAHE
Middle Name:
Last Name:OHANESSIAN
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 1:1016 E BROADWAY
Mailing Address - Street 2:104
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-4532
Mailing Address - Country:US
Mailing Address - Phone:818-259-1000
Mailing Address - Fax:
Practice Address - Street 1:1016 E BROADWAY
Practice Address - Street 2:104
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-4532
Practice Address - Country:US
Practice Address - Phone:818-259-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36995122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist