Provider Demographics
NPI:1396944989
Name:VRAM J. KARGODORIAN D.D.S.
Entity type:Organization
Organization Name:VRAM J. KARGODORIAN D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VRAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:KARGODORIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-701-5311
Mailing Address - Street 1:18250 ROSCOE BLVD
Mailing Address - Street 2:355
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325
Mailing Address - Country:US
Mailing Address - Phone:818-701-5311
Mailing Address - Fax:
Practice Address - Street 1:18250 ROSCOE BLVD
Practice Address - Street 2:355
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4226
Practice Address - Country:US
Practice Address - Phone:818-701-5311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39820261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93557-01OtherDENTICAL