Provider Demographics
NPI:1649781758
Name:GAYANE MATULIANDDS
Entity type:Organization
Organization Name:GAYANE MATULIANDDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GAYANE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MATULIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-660-5522
Mailing Address - Street 1:2650 GRIFFITH PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-2520
Mailing Address - Country:US
Mailing Address - Phone:323-660-5522
Mailing Address - Fax:818-551-9976
Practice Address - Street 1:2650 GRIFFITH PARK BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-2520
Practice Address - Country:US
Practice Address - Phone:323-660-5522
Practice Address - Fax:818-551-9976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE442141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty