Provider Demographics
NPI:1962150607
Name:HASMIK AMBARTSUMYAN DENTAL CORPORATION
Entity type:Organization
Organization Name:HASMIK AMBARTSUMYAN DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HASMIK
Authorized Official - Middle Name:
Authorized Official - Last Name:AMBARTSUMYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-666-2222
Mailing Address - Street 1:5222 1/2 W SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5710
Mailing Address - Country:US
Mailing Address - Phone:323-666-2222
Mailing Address - Fax:
Practice Address - Street 1:5222 1/2 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5710
Practice Address - Country:US
Practice Address - Phone:323-666-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental