Provider Demographics
NPI:1972933802
Name:AMBARACHYAN DENTAL CORPORATION
Entity type:Organization
Organization Name:AMBARACHYAN DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:AMBARCHYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-848-3023
Mailing Address - Street 1:27916 SECO CANYON RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-3852
Mailing Address - Country:US
Mailing Address - Phone:661-513-0655
Mailing Address - Fax:
Practice Address - Street 1:27916 SECO CANYON RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350-3852
Practice Address - Country:US
Practice Address - Phone:661-513-0655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA510391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty