Provider Demographics
NPI:1568528099
Name:ARSEN SUKIASYAN DENTAL CORPORATION
Entity Type:Organization
Organization Name:ARSEN SUKIASYAN DENTAL CORPORATION
Other - Org Name:RAINCROSS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARSEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUKIASYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-367-1345
Mailing Address - Street 1:7000 INDIANA AVE
Mailing Address - Street 2:SUITE 117
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-4154
Mailing Address - Country:US
Mailing Address - Phone:951-367-1345
Mailing Address - Fax:951-367-1347
Practice Address - Street 1:7000 INDIANA AVE
Practice Address - Street 2:SUITE 117
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4154
Practice Address - Country:US
Practice Address - Phone:951-367-1345
Practice Address - Fax:951-367-1347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49999122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG92938Medicaid