Provider Demographics
NPI:1649443516
Name:MARIYA GRIGORYAN DDS INC
Entity type:Organization
Organization Name:MARIYA GRIGORYAN DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGORYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:559-732-7224
Mailing Address - Street 1:2634 W WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-4378
Mailing Address - Country:US
Mailing Address - Phone:559-732-7224
Mailing Address - Fax:559-732-7226
Practice Address - Street 1:2634 W WALNUT AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-4378
Practice Address - Country:US
Practice Address - Phone:559-732-7224
Practice Address - Fax:559-732-7226
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARIYA GRIGORYAN DMD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-10
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty