Provider Demographics
NPI:1104918333
Name:DEIRMENJIAN, SANDRA W (DDS)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:W
Last Name:DEIRMENJIAN
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 1:2800 CASIANO RD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1512
Mailing Address - Country:US
Mailing Address - Phone:818-990-8073
Mailing Address - Fax:
Practice Address - Street 1:8761 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-2401
Practice Address - Country:US
Practice Address - Phone:818-891-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA521291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice