Provider Demographics
NPI:1588013361
Name:ISMAILYAN, ANI HAKOBYAN (DMD)
Entity Type:Individual
Prefix:
First Name:ANI
Middle Name:HAKOBYAN
Last Name:ISMAILYAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 OLD PHILLIPS RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91207-1151
Mailing Address - Country:US
Mailing Address - Phone:818-939-1923
Mailing Address - Fax:
Practice Address - Street 1:9510 HAGEMAN RD STE B
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-3953
Practice Address - Country:US
Practice Address - Phone:661-829-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS100264122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist