Provider Demographics
NPI:1124639901
Name:ARUTYUN MKRTCHYAN D.D.S. INC
Entity type:Organization
Organization Name:ARUTYUN MKRTCHYAN D.D.S. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RUZANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHONDKARYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-885-8707
Mailing Address - Street 1:1655 N MOUNT VERNON AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92411-1427
Mailing Address - Country:US
Mailing Address - Phone:909-885-8707
Mailing Address - Fax:
Practice Address - Street 1:1655 N MOUNT VERNON AVE UNIT B
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411-1427
Practice Address - Country:US
Practice Address - Phone:909-885-8707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty