Provider Demographics
NPI:1689023467
Name:ASMIK MADOULIAN DDS INC
Entity Type:Organization
Organization Name:ASMIK MADOULIAN DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASMIK
Authorized Official - Middle Name:ANDRANIK
Authorized Official - Last Name:MADOULIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-762-9112
Mailing Address - Street 1:10903 MAGNOLIA BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-3904
Mailing Address - Country:US
Mailing Address - Phone:818-762-9112
Mailing Address - Fax:818-762-4974
Practice Address - Street 1:10903 MAGNOLIA BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-3904
Practice Address - Country:US
Practice Address - Phone:818-762-9112
Practice Address - Fax:818-762-4974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45287261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1881781201OtherNPI