Provider Demographics
NPI:1962600742
Name:ALENOUSH BAGHDASARYAN,D.D.S., A PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:ALENOUSH BAGHDASARYAN,D.D.S., A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALENOUSH
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGHDASARYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-956-3733
Mailing Address - Street 1:457 PALM DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-3221
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:457 PALM DR STE 100
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-3221
Practice Address - Country:US
Practice Address - Phone:818-956-3733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA377831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty