Provider Demographics
NPI:1205999091
Name:MARDIROSSIAN, ARMEN (DDS MS)
Entity type:Individual
Prefix:DR
First Name:ARMEN
Middle Name:
Last Name:MARDIROSSIAN
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13197 CENTRAL AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-4178
Mailing Address - Country:US
Mailing Address - Phone:909-613-1366
Mailing Address - Fax:909-613-1477
Practice Address - Street 1:13197 CENTRAL AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710
Practice Address - Country:US
Practice Address - Phone:909-613-1366
Practice Address - Fax:909-613-1477
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA459191223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics