Provider Demographics
NPI:1508085622
Name:GRIGORIAN, GOAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:GOAR
Middle Name:
Last Name:GRIGORIAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3161 LOS FELIZ BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-1522
Mailing Address - Country:US
Mailing Address - Phone:323-663-2606
Mailing Address - Fax:323-906-0072
Practice Address - Street 1:3161 LOS FELIZ BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-1522
Practice Address - Country:US
Practice Address - Phone:323-663-2606
Practice Address - Fax:323-906-0072
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA458681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice