Provider Demographics
NPI:1851439913
Name:LALEIAN, ANTRANIK TANIEL (DDS)
Entity Type:Individual
Prefix:MR
First Name:ANTRANIK
Middle Name:TANIEL
Last Name:LALEIAN
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 1:300 W GLENOAKS BLVD
Mailing Address - Street 2:#203
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2941
Mailing Address - Country:US
Mailing Address - Phone:818-500-3991
Mailing Address - Fax:818-500-3914
Practice Address - Street 1:300 W GLENOAKS BLVD
Practice Address - Street 2:#203
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2941
Practice Address - Country:US
Practice Address - Phone:818-500-3991
Practice Address - Fax:818-500-3914
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA423491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB42349-01Medicaid