Provider Demographics
NPI:1215425293
Name:ARAM GRIGORYAN DDS DENTAL CORP
Entity type:Organization
Organization Name:ARAM GRIGORYAN DDS DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGORYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-424-5505
Mailing Address - Street 1:9146 SEPULVEDA BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-6948
Mailing Address - Country:US
Mailing Address - Phone:818-830-7000
Mailing Address - Fax:818-830-7013
Practice Address - Street 1:9146 SEPULVEDA BLVD STE A
Practice Address - Street 2:
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-6948
Practice Address - Country:US
Practice Address - Phone:818-830-7000
Practice Address - Fax:818-830-7013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64956122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty