Provider Demographics
NPI:1780324970
Name:DR. MINASYAN DENTISTRY INC.
Entity type:Organization
Organization Name:DR. MINASYAN DENTISTRY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KHAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MINASYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-210-1010
Mailing Address - Street 1:5953 LAUREL CANYON BLVD UNIT B
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-1237
Mailing Address - Country:US
Mailing Address - Phone:818-210-1010
Mailing Address - Fax:
Practice Address - Street 1:5953 LAUREL CANYON BLVD UNIT B
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-1237
Practice Address - Country:US
Practice Address - Phone:818-210-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental