Provider Demographics
NPI:1669955282
Name:DR. HAMLET AVANESIAN DDS A PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:DR. HAMLET AVANESIAN DDS A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HAMLET
Authorized Official - Middle Name:
Authorized Official - Last Name:AVANESIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-659-7200
Mailing Address - Street 1:1902 W GLENOAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-1616
Mailing Address - Country:US
Mailing Address - Phone:818-638-7200
Mailing Address - Fax:818-657-7080
Practice Address - Street 1:701 S GLENOAKS BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1417
Practice Address - Country:US
Practice Address - Phone:818-638-7200
Practice Address - Fax:818-657-7080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-10
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty