Provider Demographics
NPI:1104254374
Name:V A HALAJIAN DENTAL CORPORATION
Entity type:Organization
Organization Name:V A HALAJIAN DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIC
Authorized Official - Middle Name:
Authorized Official - Last Name:HALAJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-416-4776
Mailing Address - Street 1:230 N MARYLAND AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4261
Mailing Address - Country:US
Mailing Address - Phone:818-547-2804
Mailing Address - Fax:818-502-1197
Practice Address - Street 1:230 N MARYLAND AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4261
Practice Address - Country:US
Practice Address - Phone:818-547-2804
Practice Address - Fax:818-502-1197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA583801223P0221X
CA306241223P0300X
CA558291223S0112X
CA577931223X0400X
CA567171223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty