Provider Demographics
NPI:1508052473
Name:DERAGOBIAN, ARAM TERTAT (DDS)
Entity Type:Individual
Prefix:DR
First Name:ARAM
Middle Name:TERTAT
Last Name:DERAGOBIAN
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 1:25997 LAWTON AVE
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3838
Mailing Address - Country:US
Mailing Address - Phone:909-528-9894
Mailing Address - Fax:909-796-5700
Practice Address - Street 1:25997 LAWTON AVE
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3838
Practice Address - Country:US
Practice Address - Phone:909-528-9894
Practice Address - Fax:909-796-5700
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56039122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist