Provider Demographics
NPI:1558606723
Name:ARAKELYAN AZNAVOUR DENTAL CORPORATION
Entity Type:Organization
Organization Name:ARAKELYAN AZNAVOUR DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SARKIS
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:AZNAVOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-335-3306
Mailing Address - Street 1:175 N. PENNSYLVANIA AVE SUITE 3
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741
Mailing Address - Country:US
Mailing Address - Phone:626-335-3306
Mailing Address - Fax:
Practice Address - Street 1:175 N PENNSYLVANIA AVE STE 3
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-3316
Practice Address - Country:US
Practice Address - Phone:626-335-3306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55946122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty