Healthcare Provider Details

I. General information

NPI: 1750057535
Provider Name (Legal Business Name): BURBANK TAROIAN DENTAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2021
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4406 W MAGNOLIA BLVD
BURBANK CA
91505-2729
US

IV. Provider business mailing address

4406 W MAGNOLIA BLVD
BURBANK CA
91505-2729
US

V. Phone/Fax

Practice location:
  • Phone: 818-260-0274
  • Fax:
Mailing address:
  • Phone: 818-260-0274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HARMICK TAROIAN
Title or Position: PRESIDENT
Credential: DDS
Phone: 818-260-0274