Provider Demographics
NPI:1922086651
Name:MATULIAN, GAYANE ANDRANIK (DDS)
Entity Type:Individual
Prefix:DR
First Name:GAYANE
Middle Name:ANDRANIK
Last Name:MATULIAN
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 1:2650 GRIFFITH PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-2520
Mailing Address - Country:US
Mailing Address - Phone:323-660-5522
Mailing Address - Fax:818-551-9976
Practice Address - Street 1:2650 GRIFFITH PARK BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-2520
Practice Address - Country:US
Practice Address - Phone:323-660-5522
Practice Address - Fax:818-551-9976
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA442141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice