Provider Demographics
NPI:1427213685
Name:PRODENT CARE, DENTAL PRACTICE OF TEREZA HAMBARCHIAN, DDS, INC
Entity type:Organization
Organization Name:PRODENT CARE, DENTAL PRACTICE OF TEREZA HAMBARCHIAN, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TEREZA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMBARCHIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-489-2409
Mailing Address - Street 1:213 N ORANGE STREET
Mailing Address - Street 2:SUITE F
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203
Mailing Address - Country:US
Mailing Address - Phone:818-241-3155
Mailing Address - Fax:
Practice Address - Street 1:213 N ORANGE STREET
Practice Address - Street 2:SUITE F
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203
Practice Address - Country:US
Practice Address - Phone:818-241-3155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-26
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA535981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD53598Medicaid
CA53598OtherSTATE LICENSE