Provider Demographics
NPI:1821214784
Name:DEUKMEDJIAN, PHAEDRA (DDS MS)
Entity type:Individual
Prefix:DR
First Name:PHAEDRA
Middle Name:
Last Name:DEUKMEDJIAN
Suffix:
Gender:F
Credentials:DDS MS
Other - Prefix:DR
Other - First Name:FEDRA
Other - Middle Name:
Other - Last Name:ABRAHAMIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS MS
Mailing Address - Street 1:7345 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 330
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1963
Mailing Address - Country:US
Mailing Address - Phone:818-346-6282
Mailing Address - Fax:818-346-5174
Practice Address - Street 1:7345 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 330
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1963
Practice Address - Country:US
Practice Address - Phone:818-346-6282
Practice Address - Fax:818-346-5174
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA515381223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry