Provider Demographics
NPI:1457562043
Name:MIKAELIAN, ARMEN
Entity Type:Individual
Prefix:DR
First Name:ARMEN
Middle Name:
Last Name:MIKAELIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10455 LOWER AZUSA RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-3470
Mailing Address - Country:US
Mailing Address - Phone:626-444-3744
Mailing Address - Fax:626-444-3944
Practice Address - Street 1:10455 LOWER AZUSA RD
Practice Address - Street 2:
Practice Address - City:TEMPLE CITY
Practice Address - State:CA
Practice Address - Zip Code:91780-3470
Practice Address - Country:US
Practice Address - Phone:626-444-3744
Practice Address - Fax:626-444-3944
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA524331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice