Provider Demographics
NPI:1851546493
Name:VAHAN GRIGORYAN, DDS, INC.
Entity Type:Organization
Organization Name:VAHAN GRIGORYAN, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VAHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGORYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-428-5111
Mailing Address - Street 1:7993 SIERRA AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-3330
Mailing Address - Country:US
Mailing Address - Phone:909-428-5111
Mailing Address - Fax:909-428-5757
Practice Address - Street 1:7993 SIERRA AVE
Practice Address - Street 2:SUITE D
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-3330
Practice Address - Country:US
Practice Address - Phone:909-428-5111
Practice Address - Fax:909-428-5757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA495361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty