Provider Demographics
NPI:1790046282
Name:DELAKYAN, SPARTAK (DDS)
Entity Type:Individual
Prefix:DR
First Name:SPARTAK
Middle Name:
Last Name:DELAKYAN
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 1:14231 COHASSET ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-1427
Mailing Address - Country:US
Mailing Address - Phone:818-523-3005
Mailing Address - Fax:
Practice Address - Street 1:14231 COHASSET ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-1427
Practice Address - Country:US
Practice Address - Phone:818-523-3005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61368122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA$$$$$$$$$Medicare PIN