Provider Demographics
NPI:1427055763
Name:GEORGE S. GHOLDOIAN D.D.S., INC.
Entity type:Organization
Organization Name:GEORGE S. GHOLDOIAN D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:S
Authorized Official - Last Name:GHOLDOIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-923-8141
Mailing Address - Street 1:10501 LAKEWOOD BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-2709
Mailing Address - Country:US
Mailing Address - Phone:562-923-8141
Mailing Address - Fax:
Practice Address - Street 1:10501 LAKEWOOD BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-2709
Practice Address - Country:US
Practice Address - Phone:562-923-8141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA176841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB17684-O1OtherDENTI-CAL