Provider Demographics
NPI:1720118201
Name:TERTERYAN, ARMEN (DDS)
Entity Type:Individual
Prefix:
First Name:ARMEN
Middle Name:
Last Name:TERTERYAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6325 TOPANGA CANYON BLVD STE 320
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-2012
Mailing Address - Country:US
Mailing Address - Phone:818-716-7966
Mailing Address - Fax:818-716-8838
Practice Address - Street 1:6325 TOPANGA CANYON BLVD STE 320
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-2012
Practice Address - Country:US
Practice Address - Phone:818-716-7966
Practice Address - Fax:818-716-8838
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA511421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA42-1613368OtherTIN