Provider Demographics
NPI:1518038611
Name:VARTABEDIAN, PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:VARTABEDIAN
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 1:1090 N FORBES ST
Mailing Address - Street 2:
Mailing Address - City:LAKEPORT
Mailing Address - State:CA
Mailing Address - Zip Code:95453-4341
Mailing Address - Country:US
Mailing Address - Phone:707-263-1496
Mailing Address - Fax:707-263-1498
Practice Address - Street 1:1090 N FORBES ST
Practice Address - Street 2:
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-4341
Practice Address - Country:US
Practice Address - Phone:707-263-1496
Practice Address - Fax:707-263-1498
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA395831223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA39583OtherDENTAL LICENSE