Provider Demographics
NPI:1245374933
Name:BAGHDASARYAN, ALENOUSH (DDS)
Entity type:Individual
Prefix:DR
First Name:ALENOUSH
Middle Name:
Last Name:BAGHDASARYAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 PALM DR
Mailing Address - Street 2:#100
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202
Mailing Address - Country:US
Mailing Address - Phone:818-956-3733
Mailing Address - Fax:818-956-3746
Practice Address - Street 1:457 PALM DR
Practice Address - Street 2:#100
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202
Practice Address - Country:US
Practice Address - Phone:818-956-3733
Practice Address - Fax:818-956-3746
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37783122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA174820Medicare ID - Type Unspecified