Provider Demographics
NPI:1639548050
Name:TOWN CENTER DENTISTRY
Entity Type:Organization
Organization Name:TOWN CENTER DENTISTRY
Other - Org Name:ESTHETIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:HAMLET
Authorized Official - Middle Name:
Authorized Official - Last Name:AVANESIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-548-7700
Mailing Address - Street 1:316 E BROADWAY # A
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1011
Mailing Address - Country:US
Mailing Address - Phone:818-548-7700
Mailing Address - Fax:818-548-7697
Practice Address - Street 1:1902 W GLENOAKS BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-1616
Practice Address - Country:US
Practice Address - Phone:818-638-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50563122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9338001OtherDENTI-CAL