Provider Demographics
NPI:1952490781
Name:TINGILIAN, ROBERT (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:TINGILIAN
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 1:2624 HOLLISTER TER
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-3119
Mailing Address - Country:US
Mailing Address - Phone:818-502-0117
Mailing Address - Fax:
Practice Address - Street 1:5151 HAZELTINE AVE
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-1116
Practice Address - Country:US
Practice Address - Phone:818-788-2023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51380122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist