Provider Demographics
NPI:1821586249
Name:HOVASAPIAN, ANGINEH (DDS)
Entity Type:Individual
Prefix:
First Name:ANGINEH
Middle Name:
Last Name:HOVASAPIAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 W CALIFORNIA AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-2183
Mailing Address - Country:US
Mailing Address - Phone:818-433-0617
Mailing Address - Fax:
Practice Address - Street 1:461 W CALIFORNIA AVE APT 8
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2183
Practice Address - Country:US
Practice Address - Phone:818-433-0617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-01
Last Update Date:2019-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA104388122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program