Provider Demographics
NPI:1497195887
Name:NATALIE DERBOGHOSSIANS DDS INC
Entity Type:Organization
Organization Name:NATALIE DERBOGHOSSIANS DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DERBOGHOSSIANS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-319-3197
Mailing Address - Street 1:2340 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-2449
Mailing Address - Country:US
Mailing Address - Phone:818-319-3197
Mailing Address - Fax:
Practice Address - Street 1:2340 LAKE AVE
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-2449
Practice Address - Country:US
Practice Address - Phone:818-319-3197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-28
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55001122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty