Provider Demographics
NPI:1134743123
Name:ANNIE ABOULIAN DENTAL GROUP DENTAL CORPORATION
Entity type:Organization
Organization Name:ANNIE ABOULIAN DENTAL GROUP DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:AGHAJANIAN-ABOULIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-505-8083
Mailing Address - Street 1:1400 W OLIVE AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-2416
Mailing Address - Country:US
Mailing Address - Phone:818-736-5202
Mailing Address - Fax:
Practice Address - Street 1:1400 W OLIVE AVE STE 201
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-2416
Practice Address - Country:US
Practice Address - Phone:818-822-9136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-04
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental