Provider Demographics
NPI:1710412309
Name:KARAKOZIAN AND KOTCHOUNIAN DENTAL CORP
Entity Type:Organization
Organization Name:KARAKOZIAN AND KOTCHOUNIAN DENTAL CORP
Other - Org Name:DENTAL DESIGN STUDIO CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TALIN
Authorized Official - Middle Name:KOTCHOUNIAN
Authorized Official - Last Name:PETROSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-538-8899
Mailing Address - Street 1:12265 VENTURA BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2528
Mailing Address - Country:US
Mailing Address - Phone:818-538-8899
Mailing Address - Fax:818-334-4495
Practice Address - Street 1:12265 VENTURA BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2528
Practice Address - Country:US
Practice Address - Phone:818-538-8899
Practice Address - Fax:818-334-4495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58653122300000X
CA56643122300000X
CA586361223E0200X
CA611601223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty