Provider Demographics
NPI:1790912210
Name:OVSEP LUSINYAN D.D.S.
Entity Type:Organization
Organization Name:OVSEP LUSINYAN D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:OVSEP
Authorized Official - Middle Name:
Authorized Official - Last Name:LUSINYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-500-7978
Mailing Address - Street 1:501 W GLENOAKS BLVD
Mailing Address - Street 2:#12
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2896
Mailing Address - Country:US
Mailing Address - Phone:818-500-7978
Mailing Address - Fax:818-500-7827
Practice Address - Street 1:501 W GLENOAKS BLVD
Practice Address - Street 2:#12
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2896
Practice Address - Country:US
Practice Address - Phone:818-500-7978
Practice Address - Fax:818-500-7827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB36314122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty