Provider Demographics
NPI:1952675977
Name:MIRZOYAN DENTAL CORPORATION
Entity Type:Organization
Organization Name:MIRZOYAN DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LILIT
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRZOYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-551-1127
Mailing Address - Street 1:1127 N PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2358
Mailing Address - Country:US
Mailing Address - Phone:818-551-1127
Mailing Address - Fax:818-551-1167
Practice Address - Street 1:1127 N PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2358
Practice Address - Country:US
Practice Address - Phone:818-551-1127
Practice Address - Fax:818-551-1167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA599381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty