Provider Demographics
NPI:1902362718
Name:MHER ASATRYAN DDS INC
Entity Type:Organization
Organization Name:MHER ASATRYAN DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ASATRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-841-8607
Mailing Address - Street 1:928 N SAN FERNANDO BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-4318
Mailing Address - Country:US
Mailing Address - Phone:818-841-8607
Mailing Address - Fax:
Practice Address - Street 1:928 N SAN FERNANDO BLVD STE E
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-4318
Practice Address - Country:US
Practice Address - Phone:818-841-8607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-17
Last Update Date:2019-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA55649OtherDENTAL LICENCE