Provider Demographics
NPI:1801035381
Name:ANTRANIG GARY KELLEYAN DDS INC.
Entity Type:Organization
Organization Name:ANTRANIG GARY KELLEYAN DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTRANIG
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:KELLEYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-280-4122
Mailing Address - Street 1:616 N GARFIELD AVE STE 404
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1101
Mailing Address - Country:US
Mailing Address - Phone:626-280-4122
Mailing Address - Fax:626-280-4124
Practice Address - Street 1:616 N GARFIELD AVE STE 404
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1101
Practice Address - Country:US
Practice Address - Phone:626-280-4122
Practice Address - Fax:626-280-4124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA524091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty