Provider Demographics
NPI:1972869337
Name:VATCHE WASSILIAN DDS APDC
Entity Type:Organization
Organization Name:VATCHE WASSILIAN DDS APDC
Other - Org Name:LOMA VISTA DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VATCHE
Authorized Official - Middle Name:SARKIS
Authorized Official - Last Name:WASSILIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-323-7777
Mailing Address - Street 1:1504 SHAW AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-4028
Mailing Address - Country:US
Mailing Address - Phone:559-323-7777
Mailing Address - Fax:559-323-7776
Practice Address - Street 1:1504 SHAW AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-4028
Practice Address - Country:US
Practice Address - Phone:559-323-7777
Practice Address - Fax:559-323-7776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-10
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA582551223G0001X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty