Provider Demographics
NPI:1720421225
Name:DER BOGHOSSIAN, CARLOS (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:DER BOGHOSSIAN
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 1:6160 ARLINGTON AVE
Mailing Address - Street 2:D4
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-1944
Mailing Address - Country:US
Mailing Address - Phone:951-637-0013
Mailing Address - Fax:951-637-0016
Practice Address - Street 1:6160 ARLINGTON AVE
Practice Address - Street 2:D4
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-1944
Practice Address - Country:US
Practice Address - Phone:951-637-0013
Practice Address - Fax:951-637-0016
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA388321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice