Provider Demographics
NPI:1891818274
Name:BOYADJIAN, ALINE N (DDS)
Entity Type:Individual
Prefix:MS
First Name:ALINE
Middle Name:N
Last Name:BOYADJIAN
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 1:19231 VICTORY BLVD STE 357
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-6354
Mailing Address - Country:US
Mailing Address - Phone:818-785-5445
Mailing Address - Fax:818-785-2643
Practice Address - Street 1:19231 VICTORY BLVD STE 357
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-6354
Practice Address - Country:US
Practice Address - Phone:818-785-5445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52585122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93397-01Medicare ID - Type Unspecified