Provider Demographics
NPI:1801048129
Name:JIL-AGOPIAN PROF. DENTAL CORPORATION
Entity type:Organization
Organization Name:JIL-AGOPIAN PROF. DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARA
Authorized Official - Middle Name:
Authorized Official - Last Name:JIL-AGOPIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:818-458-9628
Mailing Address - Street 1:12660 DORINA PL
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-1417
Mailing Address - Country:US
Mailing Address - Phone:818-458-9628
Mailing Address - Fax:818-832-4301
Practice Address - Street 1:10727 WHITE OAK AVE
Practice Address - Street 2:#215
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-4631
Practice Address - Country:US
Practice Address - Phone:818-832-4331
Practice Address - Fax:818-832-4301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-17
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA570821223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty