Healthcare Provider Details

I. General information

NPI: 1912362633
Provider Name (Legal Business Name): BELLA MNATSAKANYAN D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2015
Last Update Date: 05/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9408 VIA PATRICIA
BURBANK CA
91504-1324
US

IV. Provider business mailing address

9408 VIA PATRICIA
BURBANK CA
91504-1324
US

V. Phone/Fax

Practice location:
  • Phone: 818-243-3755
  • Fax:
Mailing address:
  • Phone: 818-243-3755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number65325
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: