Provider Demographics
NPI:1629289798
Name:TATULYAN, SERGEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:SERGEY
Middle Name:
Last Name:TATULYAN
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 1:18856 ROSCOE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-6302
Mailing Address - Country:US
Mailing Address - Phone:818-885-7116
Mailing Address - Fax:818-885-1904
Practice Address - Street 1:18856 ROSCOE BLVD STE A
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-6302
Practice Address - Country:US
Practice Address - Phone:818-885-7116
Practice Address - Fax:818-885-1904
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA552111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice