Provider Demographics
NPI:1134149032
Name:ARUTYUNYAN, PAVEL (DDS)
Entity type:Individual
Prefix:MR
First Name:PAVEL
Middle Name:
Last Name:ARUTYUNYAN
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 1:11166 TUJUNGA CANYON BLVD
Mailing Address - Street 2:
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91042-1228
Mailing Address - Country:US
Mailing Address - Phone:818-352-9383
Mailing Address - Fax:
Practice Address - Street 1:501 S GLENDALE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-2224
Practice Address - Country:US
Practice Address - Phone:818-550-0777
Practice Address - Fax:818-550-0711
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA520381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice