Provider Demographics
NPI:1821402538
Name:NIGOGHOSIAN, JOHNNY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:
Last Name:NIGOGHOSIAN
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 1:251 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-2359
Mailing Address - Country:US
Mailing Address - Phone:626-429-9723
Mailing Address - Fax:
Practice Address - Street 1:251 GRAND AVE
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-2359
Practice Address - Country:US
Practice Address - Phone:626-429-9723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63485122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist