Provider Demographics
NPI:1306104245
Name:Z DENTAL GROUP
Entity type:Organization
Organization Name:Z DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARSEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGHDAGYULYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-936-9997
Mailing Address - Street 1:6320 COMMODORE SLOAT DRIVE
Mailing Address - Street 2:DENTAL SUITE
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5453
Mailing Address - Country:US
Mailing Address - Phone:323-936-9997
Mailing Address - Fax:323-936-9998
Practice Address - Street 1:6320 COMMODORE SLOAT DR
Practice Address - Street 2:DENTAL SUITE
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5453
Practice Address - Country:US
Practice Address - Phone:323-936-9997
Practice Address - Fax:323-936-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-29
Last Update Date:2012-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty