Provider Demographics
NPI:1497908131
Name:ARA G. JIL-AGOPIAN DENTAL CORPORATION
Entity Type:Organization
Organization Name:ARA G. JIL-AGOPIAN DENTAL CORPORATION
Other - Org Name:AGOPIAN DENTAL PRACTICE OF SANTA CLARITA, APC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARA
Authorized Official - Middle Name:
Authorized Official - Last Name:JIL-AGOPIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:818-458-9628
Mailing Address - Street 1:12660 DORINA PL
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-1417
Mailing Address - Country:US
Mailing Address - Phone:818-458-9628
Mailing Address - Fax:661-252-2336
Practice Address - Street 1:27225 CAMP PLENTY RD
Practice Address - Street 2:#10A
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91351-2654
Practice Address - Country:US
Practice Address - Phone:661-252-7641
Practice Address - Fax:661-252-2336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA510821223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty