Provider Demographics
NPI:1588958995
Name:GHORBANIAN PLLC
Entity type:Organization
Organization Name:GHORBANIAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:ELPERIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-457-5050
Mailing Address - Street 1:1648 PLAZA WAY
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-4325
Mailing Address - Country:US
Mailing Address - Phone:509-522-2220
Mailing Address - Fax:509-522-0171
Practice Address - Street 1:1648 PLAZA WAY
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-4325
Practice Address - Country:US
Practice Address - Phone:509-522-2220
Practice Address - Fax:509-522-0171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60169589122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty