Provider Demographics
NPI:1578685236
Name:HARTOONIAN, ARMEN (DMD, CAGS)
Entity Type:Individual
Prefix:
First Name:ARMEN
Middle Name:
Last Name:HARTOONIAN
Suffix:
Gender:M
Credentials:DMD, CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S GLENOAKS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1448
Mailing Address - Country:US
Mailing Address - Phone:818-566-4438
Mailing Address - Fax:818-566-4438
Practice Address - Street 1:401 S GLENOAKS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1448
Practice Address - Country:US
Practice Address - Phone:818-566-4438
Practice Address - Fax:818-566-4438
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21590122300000X
CA590651223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist