Provider Demographics
NPI:1942536149
Name:OVANESIAN, GRISHA ROLAND (DDS)
Entity Type:Individual
Prefix:DR
First Name:GRISHA
Middle Name:ROLAND
Last Name:OVANESIAN
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 1:68820 RAMON RD
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-3337
Mailing Address - Country:US
Mailing Address - Phone:760-770-0236
Mailing Address - Fax:760-770-9758
Practice Address - Street 1:68820 RAMON RD
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-3337
Practice Address - Country:US
Practice Address - Phone:760-770-0236
Practice Address - Fax:760-770-9758
Is Sole Proprietor?:No
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA552351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice