Provider Demographics
NPI:1881781201
Name:MADOULIAN, ASMIK A (DDS)
Entity type:Individual
Prefix:MRS
First Name:ASMIK
Middle Name:A
Last Name:MADOULIAN
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 1:10903 MAGNOLIA BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601
Mailing Address - Country:US
Mailing Address - Phone:818-762-9112
Mailing Address - Fax:818-762-4974
Practice Address - Street 1:10903 MAGNOLIA BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601
Practice Address - Country:US
Practice Address - Phone:818-762-9112
Practice Address - Fax:818-762-4974
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45287122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist