Provider Demographics
NPI:1215265640
Name:SUSAN JARAKIAN DDS INC
Entity type:Organization
Organization Name:SUSAN JARAKIAN DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JARAKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-648-7240
Mailing Address - Street 1:18531 ROSCOE BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-4641
Mailing Address - Country:US
Mailing Address - Phone:818-772-1800
Mailing Address - Fax:
Practice Address - Street 1:18531 ROSCOE BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-4641
Practice Address - Country:US
Practice Address - Phone:818-772-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550321223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty