Provider Demographics
NPI:1578742789
Name:TER POGHOSSIAN, VARTAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:VARTAN
Middle Name:
Last Name:TER POGHOSSIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 PIEDMONT AVE UNIT 318
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-6117
Mailing Address - Country:US
Mailing Address - Phone:818-913-5030
Mailing Address - Fax:
Practice Address - Street 1:444 PIEDMONT AVE UNIT 318
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-6117
Practice Address - Country:US
Practice Address - Phone:818-913-5030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56017122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist