Provider Demographics
NPI:1689064826
Name:ABRAAMYAN PROFESSIONAL DENTAL CORP
Entity Type:Organization
Organization Name:ABRAAMYAN PROFESSIONAL DENTAL CORP
Other - Org Name:SUNRISE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELMIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAAMYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-520-1718
Mailing Address - Street 1:901 SUNRISE AVE
Mailing Address - Street 2:A1
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4519
Mailing Address - Country:US
Mailing Address - Phone:916-520-1717
Mailing Address - Fax:
Practice Address - Street 1:901 SUNRISE AVE
Practice Address - Street 2:A1
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4519
Practice Address - Country:US
Practice Address - Phone:916-520-1717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42263122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty