Provider Demographics
NPI:1629147038
Name:YETENEKIAN-GETTAS, ARAXIE (DMD)
Entity Type:Individual
Prefix:
First Name:ARAXIE
Middle Name:
Last Name:YETENEKIAN-GETTAS
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 1:2028 W PICO BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-5011
Mailing Address - Country:US
Mailing Address - Phone:213-380-5506
Mailing Address - Fax:213-380-0754
Practice Address - Street 1:2028 W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-5011
Practice Address - Country:US
Practice Address - Phone:213-380-5506
Practice Address - Fax:213-380-0754
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA351861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93782Medicaid