Provider Demographics
NPI:1497268700
Name:DEIRMENJIAN DENTAL GROUP INC
Entity Type:Organization
Organization Name:DEIRMENJIAN DENTAL GROUP INC
Other - Org Name:DESERT DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:BAROUIR
Authorized Official - Middle Name:
Authorized Official - Last Name:DEIRMENJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-241-3336
Mailing Address - Street 1:12640 HESPERIA RD STE C
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-7753
Mailing Address - Country:US
Mailing Address - Phone:760-241-3336
Mailing Address - Fax:760-243-7247
Practice Address - Street 1:12640 HESPERIA RD STE C
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-7753
Practice Address - Country:US
Practice Address - Phone:760-241-3336
Practice Address - Fax:760-243-7247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-08
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA408041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty