Provider Demographics
NPI:1578261368
Name:GRISHA R. OVANESIAN DDS INC
Entity Type:Organization
Organization Name:GRISHA R. OVANESIAN DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:GRISHA
Authorized Official - Middle Name:R
Authorized Official - Last Name:OVANESIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-770-0236
Mailing Address - Street 1:68820 RAMON RD. SOUTHWEST DENTAL
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234
Mailing Address - Country:US
Mailing Address - Phone:760-770-0236
Mailing Address - Fax:760-770-9758
Practice Address - Street 1:68820 RAMON RD. SOUTHWEST DENTAL
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234
Practice Address - Country:US
Practice Address - Phone:760-770-0236
Practice Address - Fax:760-770-9758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1225364193OtherOK DENTAL PARTNERSHIP