Provider Demographics
NPI:1336215219
Name:DAVTIAN, PARGEV (DDS)
Entity Type:Individual
Prefix:DR
First Name:PARGEV
Middle Name:
Last Name:DAVTIAN
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 1:1306 W SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710
Mailing Address - Country:US
Mailing Address - Phone:310-891-2277
Mailing Address - Fax:310-891-3877
Practice Address - Street 1:1306 W SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710
Practice Address - Country:US
Practice Address - Phone:310-891-2277
Practice Address - Fax:310-891-3877
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA386641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB3866401Medicaid