Provider Demographics
NPI:1720342439
Name:OVSEPYAN, TIGRAN TICO (DMD)
Entity Type:Individual
Prefix:DR
First Name:TIGRAN
Middle Name:TICO
Last Name:OVSEPYAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 KITTY'S LANE
Mailing Address - Street 2:
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91042
Mailing Address - Country:US
Mailing Address - Phone:818-521-5334
Mailing Address - Fax:
Practice Address - Street 1:6301 KITTYS LN
Practice Address - Street 2:
Practice Address - City:TUJUNGA
Practice Address - State:CA
Practice Address - Zip Code:91042-3476
Practice Address - Country:US
Practice Address - Phone:818-521-5334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA614211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOVSEPYANMedicaid
CAOVSEPYANMedicare Oscar/Certification
CAOVSEPYANMedicaid
CAOVSEPYANMedicare PIN