Provider Demographics
NPI:1558526244
Name:ALBERT MELIKYAN DDS, INC.
Entity Type:Organization
Organization Name:ALBERT MELIKYAN DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MELIKYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-497-5958
Mailing Address - Street 1:16440 VANOWEN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE BALBOA
Mailing Address - State:CA
Mailing Address - Zip Code:91406-4729
Mailing Address - Country:US
Mailing Address - Phone:818-779-4900
Mailing Address - Fax:818-465-2753
Practice Address - Street 1:16440 VANOWEN ST
Practice Address - Street 2:
Practice Address - City:LAKE BALBOA
Practice Address - State:CA
Practice Address - Zip Code:91406-4729
Practice Address - Country:US
Practice Address - Phone:818-779-4900
Practice Address - Fax:818-465-2753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5208761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty