MEDICARE: BAROUIR DEIRMENJIAN DENTAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	122300000X	Dentist
2	1223E0200X	Endodontics
3	1223S0112X	Oral and Maxillofacial Surgery (Dentist)
4	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry
5	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1386305647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAROUIR DEIRMENJIAN DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	12640 HESPERIA RD STE A
Second Line	:
City	:	VICTORVILLE
State	:	CA
Zip	:	92395-7753
Country	:	US
Telephone Number	:	760-241-3336
Fax Number	:

Provider Business Practice Location Address
First Line	:	720 BROOKSIDE AVE STE 101
Second Line	:
City	:	REDLANDS
State	:	CA
Zip	:	92373-5189
Country	:	US
Telephone Number	:	909-798-4111
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	BAROUIR ARSHAG DEIRMENJIAN
Credential	:
Telephone Number	:	310-497-2211

Provider Enumeration Date	:	01/07/2022
Last Update Date	:	01/07/2022

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