Provider Demographics
NPI:1881082220
Name:KHACHATOORIAN-SANTE, CAROLINE (DDS)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:KHACHATOORIAN-SANTE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10655 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2341
Mailing Address - Country:US
Mailing Address - Phone:818-769-1111
Mailing Address - Fax:818-769-1136
Practice Address - Street 1:10655 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:TOLUCA LAKE
Practice Address - State:CA
Practice Address - Zip Code:91602-2341
Practice Address - Country:US
Practice Address - Phone:818-769-1111
Practice Address - Fax:818-769-1136
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-08
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46192122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist