Provider Demographics
NPI:1457587495
Name:ROLAND MARKARIAN DMD A DENTAL CORPORATION
Entity Type:Organization
Organization Name:ROLAND MARKARIAN DMD A DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:661-265-8884
Mailing Address - Street 1:1051 W AVENUE M14 STE C
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-1434
Mailing Address - Country:US
Mailing Address - Phone:661-265-8884
Mailing Address - Fax:661-265-0718
Practice Address - Street 1:1051 W AVENUE M14 STE C
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-1434
Practice Address - Country:US
Practice Address - Phone:661-265-8884
Practice Address - Fax:661-265-0718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-04
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA541751223G0001X
261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty