Provider Demographics
NPI:1497289029
Name:DERHARTOUNIAN DENTAL CORPORATION
Entity Type:Organization
Organization Name:DERHARTOUNIAN DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRIK
Authorized Official - Middle Name:
Authorized Official - Last Name:DERHARTONIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-725-6797
Mailing Address - Street 1:4542 RINETTI LN
Mailing Address - Street 2:
Mailing Address - City:LA CANADA FLINTRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91011-3359
Mailing Address - Country:US
Mailing Address - Phone:818-495-3141
Mailing Address - Fax:
Practice Address - Street 1:4542 RINETTI LN
Practice Address - Street 2:
Practice Address - City:LA CANADA FLINTRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91011-3359
Practice Address - Country:US
Practice Address - Phone:818-495-3141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41394122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty