Provider Demographics
NPI:1528442571
Name:BEKEREDJIAN AND AIVAZIAN DENTAL CORP., A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:BEKEREDJIAN AND AIVAZIAN DENTAL CORP., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:AIVAZIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-869-1686
Mailing Address - Street 1:10805 PARAMOUNT BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-3308
Mailing Address - Country:US
Mailing Address - Phone:562-869-1686
Mailing Address - Fax:562-861-1672
Practice Address - Street 1:10805 PARAMOUNT BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-3308
Practice Address - Country:US
Practice Address - Phone:562-869-1686
Practice Address - Fax:562-861-1672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-18
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49495122300000X
CA418871223G0001X
CA420151223P0221X
CA592101223P0221X
CA440771223P0300X
CA38036122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty