Healthcare Provider Details

I. General information

NPI: 1558875450
Provider Name (Legal Business Name): LATSHIKYAN DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2017
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8162 E SANTA ANA CANYON RD SUITE 104
ANAHEIN CA
92808
US

IV. Provider business mailing address

PO BOX 920050
DALLAS TX
75392-0050
US

V. Phone/Fax

Practice location:
  • Phone: 714-202-0765
  • Fax: 714-202-0765
Mailing address:
  • Phone: 714-845-8500
  • Fax: 303-952-0892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ELMIRA A LATSHIKYAN
Title or Position: OWNER DENTIST
Credential: DDS
Phone: 714-202-0765