Provider Demographics
NPI:1639350739
Name:BAKHTAMIAN, ALEN (DMD)
Entity Type:Individual
Prefix:
First Name:ALEN
Middle Name:
Last Name:BAKHTAMIAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 SOUTH FAIROAKS
Mailing Address - Street 2:SUITE 208
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105
Mailing Address - Country:US
Mailing Address - Phone:626-431-2654
Mailing Address - Fax:626-431-2811
Practice Address - Street 1:301 SOUTH FAIROAKS
Practice Address - Street 2:SUITE 208
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105
Practice Address - Country:US
Practice Address - Phone:626-431-2654
Practice Address - Fax:626-431-2811
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA397531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice