Provider Demographics
NPI:1710036181
Name:ARAKELYAN, ARAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:ARAM
Middle Name:
Last Name:ARAKELYAN
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 1:19523 E CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-2066
Mailing Address - Country:US
Mailing Address - Phone:626-786-6204
Mailing Address - Fax:
Practice Address - Street 1:720 N LAKE AVE STE 7
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-5810
Practice Address - Country:US
Practice Address - Phone:626-791-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52709122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB52709OtherDENTICAL TREATING PROV. #
CAG93410-01OtherDENTICAL BILLING PROVIDER